Let’s start with IDEA’s full requirement for specifying a child’s related services in his or her IEP. This appears at §300.320(a)(4) and stipulates that each child’s IEP must contain:

(4) A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child—

(i) To advance appropriately toward attaining the annual goals;

(ii) To be involved in and make progress in the general education curriculum in accordance with paragraph (a)(1) of this section, and to participate in extracurricular and other nonacademic activities; and

(iii) To be educated and participate with other children with disabilities and nondisabled children in the activities described in this section… [§300.320(a)(4)]

We’ve bolded the part of IDEA’s regulation that specifically mentions related services, because it’s important to see the context in which this term is used. It is that context, and IDEA’s own definition of related services, that will guide how a child’s IEP team considers what related services the child needs and the detail with which the team specifies them in the IEP.

Related Services, in Brief

Related services help children with disabilities benefit from their special education by providing extra help and support in needed areas, such as speaking or moving. Related services can include, but are not limited to, any of the following:

speech-language pathology and audiology services
interpreting services
psychological services
physical and occupational therapy
recreation, including therapeutic recreation
early identification and assessment of disabilities in children
counseling services, including rehabilitation counseling
orientation and mobility services
medical services for diagnostic or evaluation purposes
school health services and school nurse services
social work services in schools
parent counseling and training

Beginning with Evaluation

IDEA requires that a child be assessed in all areas related to his or her suspected disability. This evaluation must be sufficiently comprehensive so as to identify all of the child’s special education and related services needs, whether or not those needs are commonly linked to the disability category in which he or she has been classified.

Determining What Related Services a Student Needs

It is the IEP team’s responsibility to review all of the evaluation information, to identify any related services the child needs, and to include them in the IEP. Goals are written for a related service just as they are for other special education services. The IEP must also specify with respect to each service:

whenthe service will begin;
how often it will be provided and for what amount of time; and
whereit will be provided. [§300.320(a)(7)]

Each child with a disability may not require all of the related services listed above. Furthermore, the list of related services is not exhaustive and may include other developmental, corrective, or supportive services if they are required to assist a child with a disability to benefit from special education. Examples include artistic and cultural programs, art, music, and dance therapy.

The IEP is a written commitment for the delivery of services to meet a student’s educational needs. A school district must ensure that all of the related services specified in the IEP, including the amount, are provided to a student.

Changes in the amount of services listed in the IEP cannot be made without holding another IEP meeting. However, if there is no change in the overall amount of service, some adjustments in the scheduling of services may be possible without the necessity of another IEP meeting.

Related Services Personnel on the IEP Team

IDEA does not expressly require that the IEP team include related services personnel. However, if a particular related service is going to be discussed in an IEP meeting, it would be appropriate for such personnel to be included or otherwise involved in developing the IEP. IDEA states that, at the discretion of the parent or the public agency, “other individuals who have knowledge or special expertise regarding the child, including related services personnel as appropriate” may be part of a child’s IEP team.

Do parents have to pay for the related services their child receives?

No. School districts may not charge parents of eligible students with disabilities for the costs of related services that have been included on the child’s IEP. Just as special and regular education must be provided to an eligible student with a disability at no cost to the parent or guardian, so, too, must related services when the IEP team has determined that such services are required in order for the child to benefit from his or her education.

Related Services, in Detail

To add detail to the “short story” above, let’s begin with the very first part of IDEA’s definition of related services at §300.34.

§300.34 Related services.

(a) General. Related services means transportation and such developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education, and includes…

This beginning represents the core of how IDEA defines related services. The term related services is typically spoken in the same breath as special education (similar to how “peas and carrots” and “ham and eggs” go together) and, when used in IDEA, will always have the same meaning, including the part of the definition we haven’t shown you yet, which picks up where the beginning leaves off…

…and includes speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, early identification and assessment of disabilities in children, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services for diagnostic or evaluation purposes. Related services also include school health services and school nurse services, social work services in schools, and parent counseling and training.

Clearly, the list of related services is extensive–and, as already mentioned, the list is not exhaustive. These are just the services that IDEA specifically mentions. As states respond to the requirements of federal law, many have legislated their own related service requirements, which may include services beyond those specified in IDEA.

What’s Excluded as a Related Service

IDEA makes a specific exception to the list of related services: surgically implanted devices, including cochlear implants. This exception is new with IDEA 2004 and shows the advance of time and technology. A relatively new technological development, the cochlear implant is a “small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing” (National Institute on Deafness and Other Communication Disorders, 2006a). While an implant does not restore normal hearing, it does give the recipient “a useful representation of sounds in the environment and help him or her to understand speech” (Id.).

Cochlear implants are not the only surgically implanted devices. Others include: insulin pump, baclofen pump, pacemaker, G-tube, and vagus nerve stimulator device.

The exception. If a child has a surgically implanted device, the scope of the public agency’s responsibility to provide supportive related services in relation to that device is covered in IDEA’s provisions at §300.34(b), its exception. Public agencies are not responsible for optimizing these devices, maintaining them, or replacing them. Public agencies are responsible for “routine checking to determine if the external component of a surgically implanted device is turned on and working” (71 Fed. Reg. 46570) and for providing other types of services the child needs, as determined by the IEP team, including:

assistive technology (e.g., FM system);
proper classroom acoustical modifications;
educational support services (e.g., educational interpreters); and
receiving the related services (e.g., speech and language services) that are necessary for the child to benefit from special education services. (Id.)

While public agencies are not responsible for mapping a cochlear implant, they do have a role to play in providing services and supports to help children with cochlear implants. As the Department observes:

Particularly with younger children or children who have recently obtained implants, teachers and related services personnel frequently are the first to notice changes in the child’s perception of sounds that the child may be missing. This may manifest as a lack of attention or understanding on the part of the child or frustration in communicating. The changes may indicate a need for remapping, and we would expect that school personnel would communicate with the child’s parents about these issues. To the extent that adjustments to the devices are required, a specially trained professional would provide the remapping, which is not considered the responsibility of the public agency. (71 Fed. Reg. at 46570-1)

In many ways, the Department points out, there is no substantive difference between serving a child with a cochlear implant in a school setting and serving a child with a hearing aid. A “public agency is responsible for the routine checking of the external components of a surgically implanted device in much the same manner as a public agency is responsible for the proper functioning of hearing aids” (71 Fed. Reg. at 46571). What distinguishes a service covered under the Act and one that is excluded is, in large measure, “the level of expertise required” (Id.). Maintaining and monitoring a surgically implanted device require the expertise of a licensed physician or an individual with specialized technical expertise beyond that typically available from school personnel. On the other hand:

Teachers and related services providers can be taught to first check the externally worn speech processor to make sure it is turned on, the volume and sensitivity settings are correct, and the cable is connected, in much the same manner as they are taught to make sure a hearing aid is properly functioning. To allow a child to sit in a classroom when the child’s hearing aid or cochlear implant is not functioning is to effectively exclude the child from receiving an appropriate education. (Id.)

You’ll note that the exception in IDEA is carefully crafted to ensure that public agencies remain aware of, and responsible for, monitoring and maintaining “medical devices that are needed to maintain the health and safety of the child, including breathing, nutrition, or operation of other bodily functions, while the child is transported to and from school or is at school” (§300.34(b)(2)(ii)]. This clearly aligns with a public agency’s responsibility for the health-related services (see discussion of Medical Services and School Health Services and School Nurse Services further below).

The Individual Services, Defined

IDEA’s definition of related services also goes on to define each individual service. If you wish to delve into individual related services, the following discussion may be helpful. It’s drawn from NICHCY’s training curriculum Building the Legacy (see Module 1, which includes brief summaries of each related service). The services are discussed below in alphabetical order.

Audiology

The definition of audiology as a related service appears at §300.34(c)(1) and reads:

(1) Audiology includes—

(i) Identification of children with hearing loss;

(ii) Determination of the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing;

(iii) Provision of habilitative activities, such as language habilitation, auditory training, speech reading (lip-reading), hearing evaluation, and speech conservation;

(iv) Creation and administration of programs for prevention of hearing loss;

(v) Counseling and guidance of children, parents, and teachers regarding hearing loss; and

(vi) Determination of children’s needs for group and individual amplification, selecting and fitting an appropriate aid, and evaluating the effectiveness of amplification. [§300.34(c)(1)]

Audiology is primarily provided to support the needs of children with hearing loss and includes (but is not limited to) key services such as determining the range, nature, and degree of a child’s hearing loss and both group and individual needs for amplification.

The National Institute on Deafness and Other Communication Disorders (2006b) estimates that 17 of every 1,000 children under 18 have a hearing loss. More than 71,900 children, ages 6-21, are served in the U.S. under IDEA’s category of hearing impairments (U.S. Department of Education, 2006).

Some schools have hearing screening programs and staff trained to conduct audiology screenings of children. Others may participate in regional cooperatives or other arrangements that provide audiology services. Those school districts that do not have diagnostic facilities to evaluate children for hearing loss and related communication problems or central auditory processing disorders may refer children to a clinical setting, such as a hospital or audiology clinic, or make other contractual arrangements.

Counseling Services

IDEA defines counseling services as follows:

(2) Counseling services means services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel. [§300.34(c)(2)]

According to the American School Counselor Association (2007), counseling services are intended to help all children in the areas of academic achievement, personal/social development and career development. This can include helping children with personal and social concerns such as developing self-knowledge, making effective decisions, learning health choices, and improving responsibility. Counselors may also help children with future planning related to setting and reaching academic goals, developing a positive attitude toward learning, and recognizing and utilizing academic strengths.

Note that IDEA’s list of related services includes other counseling services—parent counseling and training; and rehabilitation counseling (that is, counseling specific to career development and employment preparation). These are defined separately in IDEA and are clearly different from counseling services (which are also not to be confused with psychological services).

Early Identification and Assessment of Disabilities in Children

This related service is defined at §300.34(c)(3) as follows:

(3) Early identification and assessment of disabilities in children means the implementation of a formal plan for identifying a disability as early as possible in a child’s life.

The disability and medical fields are full of information about early identification of disabilities in children as well as assessing the scope and impact of a child’s disability. This literature is focused on system-level issues such as setting up screening programs for specific disabilities (e.g., autism, speech-language impairment, visual and hearing impairments) and establishing mechanisms within the educational system by which children at risk of learning problems are quickly identified and their learning issues addressed.

As a related service, however, early identification and assessment of disability in children represents an individual service for one child. If a child’s IEP team determines that identifying and assessing the nature of a child’s disability is necessary in order for the child to benefit from his or her special education, then this related service must be listed in the child’s IEP and provided to the child by the public agency at no cost to the parents. A formal plan would be written to establish the process and procedures by which the child’s disability will be identified.

This may seem strange—identifying the disability? Isn’t that one of the purposes of evaluation? True. But disability can elude diagnosis, even as it adversely affects academic and functional performance in clear and measurable ways. Permitting states to adopt the term “developmental delay” acknowledges that it’s not always possible to say what’s causing a learning or other problem, but that intervention is still necessary. Early identification and assessment of disability in children, as a related service, acknowledges that continuing to search for and identify the disability as early as possible in a child’s life may be necessary if the child is going to derive benefit from special education.

Interpreting Services

Interpreting services were added to IDEA’s list of related services in the 2004 reauthorization and are defined at §300.34(c)(4) as follows:

(4) Interpreting services includes—

(i) The following, when used with respect to children who are deaf or hard of hearing: Oral transliteration services, cued language transliteration services, sign language transliteration and interpreting services, and transcription services, such as communication access real-time translation (CART), C-Print, and TypeWell; and

(ii) Special interpreting services for children who are deaf-blind. [§300.34(c)(4)]

Interpreting services may be new to IDEA’s definition of related services, but they are been provided over the years to many children who are deaf or hard of hearing, as part of providing them with access to instruction. The definition of interpreting services indicates a range of possible such services (e.g., oral transliteration, cued language), all of which refer to specific communication systems used within the deaf and hard-of-hearing community. To find out more about these various systems, visit such organizations as:

Laurent Clerc National Deaf Education Center
http://clerccenter.gallaudet.edu/Clerc_Center/Information_and_Resources/Info_To_Go.html/index.html
National Institute on Deafness and Other Communication Disorders Information Clearinghouse
http://www.nidcd.nih.gov/health/hearing/

Medical Services

Medical services are considered a related service only under specific conditions: when they are provided (a) by a licensed physician, and (b) for diagnostic or evaluation purposes only. This is clear from the definition at §300.34(c)(5):

(5) Medical services means services provided by a licensed physician to determine a child’s medically related disability that results in the child’s need for special education and related services.

This related service has a long and interesting history that has only gotten more interesting as medical science has advanced and children with diverse medical conditions are being educated in increasing numbers in general education classrooms. The support that many such children need in order to attend school, school districts have argued, is medical in nature, complex and continual, and is not the responsibility of public agencies because IDEA clearly states that medical services are allowable related services only when provided for diagnostic or evaluation purposes.

The case of Cedar Rapids Community School District v. Garret F., which took place in 1999, turned the gray line about the provision of related services to children with complex medical needs into a “bright line” (“Supreme Court adopts,” 1999). The U.S. Supreme Court found that, if a related service is required to enable a qualified child with a disability to remain in school, it must be provided as long as it is not a purely “medical” service. What is considered “medical,” as IDEA’s definition amply indicates, are those services that can only be provided by a licensed physician (and only for the purposes of diagnosis or evaluation). If a non-physician can deliver the services, then the service must be provided by public agencies, regardless of the staffing or fiscal burdens they may impose. Health care services that can be provided by a non-physician are not provided under the category of medical services, however. Today they would be as considered school health services and school nurse services. Examples of such services include bladder catheterization, tracheostomy tube suctioning, positioning, and monitoring of ventilator settings, to name a few.

Occupational Therapy

The term occupational therapy (OT) is defined in IDEA at §300.34(c)(6) as follows:

(6) Occupational therapy—

(i) Means services provided by a qualified occupational therapist; and

(ii) Includes—

(A) Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation;

(B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and

OT services can enhance a child’s ability to function in an educational program and may include such services as:

self-help skills or adaptive living (e.g., eating, dressing);
functional mobility (e.g., moving safely through school);
positioning (e.g., sitting appropriately in class);
sensory-motor processing (e.g., using the senses and muscles);
fine motor (e.g., writing, cutting) and gross motor performance (e.g., walking, athletic skills);
life skills training/vocational skills; and
psychosocial adaptation.

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Issue #6: Related Services for Children with Severe Disabilities Part I