Legal Implications of Providing Services to Students with Special Health
Needs
For many years, students with special health needs did not go to school.
They were considered too sick to attend school, and people thought it
would not be in their best interest to encourage school attendance. In
addition, treatment for many chronic childhood illnesses was very limited,
and children with some diagnoses did not live normal life expectancies.
In later years, many new developments were made in the treatment of
pediatric chronic illnesses. New medications, procedures and technology
resulted in much improved outcomes for children with chronic illnesses.
As quality of life and life expectancy improved, researchers began to
examine the psychological, social and emotional impact of a chronic illness
on a child. One of the things they found was that being in school not
only did not result in negative outcomes for the child, but it sometimes
even seemed to help the child in these psychosocial arenas. Other studies
went so far as to suggest that normal activities and involvement in school
could aid in the recovery of some children.
Homebound Education
In 1975, P.L. 94-142, the Education for All Handicapped Children Act,
was enacted. As educational law, this legislation ensured the right to
an education for all students, including those with special needs who
had previously been denied educational services. For children with special
health needs, as for many other groups of children with special needs,
this meant guaranteed access to educational services for the first time
in history.
Enacting new legislation was easier, perhaps, than changing attitudes
about requiring children with serious medical diagnoses to attend school.
Many educators, parents and health care professionals continued to believe
that requiring a child with a special health need to attend school would
result in negative outcomes. Reasons cited included fear the child would
be teased or rejected at school, fear he/she might get hurt or sick,
and concern that school requirements might add additional stress to an
already stress-filled situation. Children with special health needs continued
to be the one populations for whom school attendance remained optional.
During the 1970s and 1980s, homebound education was often the model
used to provide educational services and support to young people with
special health needs. It was common for a student to receive an hour
of educational services one to five times per week. This did not equate
going to school for 30 or more hours a week, and such students continued
to struggle with trying to keep up with their classmates. As more and
more students with special health needs entered school, however, educators,
parents and health care professionals began to rethink this issue. A
greater number of children with cancer, for example, were finishing treatment
for their disease and returning to normal routines. Life expectancies
for other diagnoses such as sickle cell anemia and cystic fibrosis were
improving dramatically. Children with special health needs were now viewed
as a population who not only deserved, but needed a solid educational
base in order to be employed and productive in their adult years.
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Section 504
Section 504 of the Rehabilitation Act, enacted in 1973, was the next
piece of legislation to guide educational services for children with
special health needs. Although enacted in 1973, it was not until several
years later that this piece of legislation began to be a common tool
utilized in program development for these students. This legislation
evolved from the civil rights movement, and was designed to prohibit
discrimination against individuals with disabilities. It was considered,
initially, to apply mostly to adults with disabilities, but soon became
recognized as an effective tool in ensuring equal access to educational
programs for children with disabilities.
Commonly referred to in schools simply as Section 504, this law helped “level
the playing field” at school for young people with disabilities.
This law addressed provision of services in their entirety, rather than
suggesting a student need “specifically designed instruction to
meet their unique learning needs”, or special education, as in
P.L. 94-142. In classrooms across America, accommodations and modifications
were put in place that would reduce the barriers that prevented students
with disabilities from fully accessing school programs. Oftentimes, these
were physical barriers, such as inadequate seating or the lack of an
elevator, that actually removed the possibility of accessing all school
programs for the child with a special health need. At other times, it
included barriers that did not permit the student to continue achieving
at the same rate as his/her peers. An example of this type of barrier
would be the lack of a tutor or skilled professional to help keep the
child current in assignments or help him/her get caught up upon their
return to school; modified assignments or length of assignments once
the student proved mastery, etc.
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IDEA, ADA & NCLB
P.L. 94-142 and Section 504 offered avenues to ensure best practice
was employed in planning and delivering instruction to students with
special health needs. They continue to be the most significant legislative
cornerstones to ensuring that students with special health needs receive
appropriate educational services. P.L. 94-142 has been reauthorized several
times since its debut in 1975. In 1990, the name was changed to the Individuals
with Disabilities Act (IDEA). Later reauthorizations of IDEA in 1997
and 2003 (pending), made some changes and additions to the original law,
but focused on the continuation of a fair appropriate education for all
children in the least restrictive environment. Educational services are
mandated under IDEA for students with other health impairments, orthopedic
impairments, traumatic brain injury and 8 additional categories.
The Americans with Disabilities Act (ADA), civil rights legislation
enacted in 1990, was an extension of Section 504 of the Rehabilitation
Act. The primary purpose of ADA was to ensure that persons were not discriminated
against in five areas: employment, transportation, public accommodations,
public services, and telecommunications. It does not have the direct
applicability, typically, to school situations that Section 504 has,
but does govern these areas of focus in public schools.
Finally, No Child Left Behind (NCLB), enacted in 2001, is the newest
educational legislation that will also have some impact on how children
with special health needs receive educational services. Students will
be tested, on standardized tests in each state, to determine how they
and their schools are doing in ensuring adequate yearly progress (AYP)
in elementary and secondary schools programs. The purpose of the law
is to help ensure that no child loses the opportunity for a quality education
because he or she is trapped in a failing school. Although not designed
for special education, this law will impact programming for all children.
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What Does This Mean?
Children with special health needs may benefit from being evaluated
to determine if they qualify for services either under IDEA or Section
504. Under IDEA, the child would receive a comprehensive evaluation,
utilizing a variety of assessment measures, to determine if he/she should
be identified as a student who is “other health impaired” or
another category that defines the child’s unique learning needs.
An Individualized Education Plan (IEP) is developed that clearly outlines
what types of educational and related services the child will receive,
who will provide those services and with what frequency they will be
provided. The IEP is what defines the education the child will receive
by determining the “specifically designed instruction to meet the
unique needs of the learner”. In other words, the IEP tells what
type of special education services the student needs and will receive.
The IEP includes several other components, including the child’s
present level of performance and specific goals, objectives and benchmarks
to ensure continued achievement. The IEP is reviewed and modified yearly,
and the state Department of Education monitors IEPs to ensure that school
districts are in compliance with the law.
A 504 Plan is a bit different, as it is based on civil rights legislation,
rather than educational legislation. To qualify for services under Section
504 of the Rehabilitation Act, a person must; 1) have a disability, 2)
have a history of having a disability or 3) be perceived as having a
disability. Students with less severe special health needs may be well
served by a 504 Plan. For students who need accommodations or modifications
in the learning environment or in how educational services are offered,
a 504 Plan may be just the right approach. The 504 Plan, also a written
document that identifies services, can determine what changes are needed
in the school environment to afford the student with the opportunity
to access program options and school activities, and to eliminate discrimination
due to the student’s health impairment.
It is important to incorporate one of the above mentioned methods when
planning educational services for a student with a health impairment.
Due to frequent absences, doctors visits, side effects of medications
and other effects of the diagnosis and treatment, it is likely that a
child with a special health need will benefit from a plan that guides
his/her education. Simply leaving academic progress to chance and assuming
that “everything will work out fine” is a dangerous game!
An IEP or 504 Plan will keep the student, parent, educators and others
working in the same direction.
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For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305