Legal Implications of Providing Services to Students with Special Health Needs

Historical overview

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.

Recently, many new developments were made in the treatment of pediatric chronic illnesses. New medications, procedures and technology resulted in greatly improved outcomes for children with chronic illnesses. As quality of life and life expectancy improved over the decades, researchers began examining the psychological, social and emotional impact of a chronic illness on a child. One of the things they found was that not only did school attendance not result in negative outcomes for the child, but also it helped the child in these psychosocial arenas. Other studies went so far as to suggest that the normal activities and involvement in school could help some children recover and improve.

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, than changing attitudes. Many educators, parents and healthcare professionals continued to believe that requiring a child with a special health need to attend school would harm that child. Reasons cited included fear the child would be teased or rejected at school, fear of becoming 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 only population 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 equal attending school for 30 or more hours a week, and such students continued to struggle as they tried to keep up with their classmates. However, as more and more students with special health needs entered school, 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 merely deserved but required a solid education in order to become employed and productive in their adult years.

Section 504

Capitol building.

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 commonly used to develop programs for these students. This legislation evolved from the civil rights movement, and was designed to prohibit discrimination against individuals with disabilities. It was initially considered to apply to adults with disabilities, but soon became recognized as an effective tool to ensure equal access to educational programs for children as well.

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 should receive " 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 to 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 peers, such as the lack of a tutor or skilled professional to help the child keep current in assignments or to bring the student back up to speed upon return to school. Another example of this type of barrier might be absence of modified assignments or length of assignments once the student proved mastery.

IDEA, ADA and NCLB (includes IEP)

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 re-authorized several times since its debut in 1975. In 1990, the name was changed to the Individuals with Disabilities Education Act (IDEA). Later re-authorizations of IDEA in 1997 and 2003 made some changes and additions to the original law, but focused on the continuation of a fair and 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 eight 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 impact how children with special health needs receive educational services. Students will be tested in each state, using standardized tests, to determine whether they and their school reach adequate yearly progress (AYP) in elementary and secondary school programs. The purpose of the law is to help ensure that no child loses the opportunity for a quality education simply by being trapped in a failing school. Although not designed for special education, this law will impact programming for all children.

What does this mean?

What does this all mean?

Children with special health needs may benefit from being evaluated to determine whether 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 identify those who qualify as "other health impaired" or another category that would define the child's unique learning needs. An Individualized Education Plan (IEP) is then developed to clearly outline the types of educational and related services the child should receive, who will provide those services and how often they should be provided. The IEP thus 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 slightly different, because 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 fall into one of these categories:

  1. the student has a disability
  2. the student has a history of having a disability
  3. the student is perceived as having a disability

Students with less severe special health needs might 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 might be the best approach. The 504 Plan is also a written document that identifies specific services. It can determine the changes needed in the school environment to afford the student the opportunity to access program options and school activities, and can 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, medical appointments, 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 educators as they work to provide adequate educational opportunities. 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 everyone, including the student, the parents and educators, working in the same direction.