Special Education Concerns for the 2020-2021 School Year

How physicians can advocate for their patients with special education needs

child in wheelchair

The American Academy of Pediatrics has been strident about its view that children should go back to school in person while taking steps to limit the spread of SARS-CoV-2 virus, according to Lainie Holman, MD, a physiatrist in the Department of Pediatric Physical Medicine and Rehabilitation at Cleveland Clinic Children’s Hospital for Rehabilitation.

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“In a perfect world, all children would attend school in-person,” says Dr. Holman. “I think most pediatricians would agree that having children in a brick-and-mortar school is better for them in general and in terms of development. This is especially true for children who are marginalized, for whom school is a safety net.”

“In-person schools are even more important for children with disabilities,” Dr. Holman continues. “Although some school districts may believe it is easier or more cost-effective to keep these children on remote-learning plans, these are the kids who need to be in school the most. They are also the kids who are least likely to have good internet access and support for virtual studies at home.”

Children with disabilities are disproportionately impoverished and otherwise marginalized. Research indicates that they are more likely to be of racial minority, have adverse childhood experiences and live in single-parent households. These children benefit greatly from school attendance, where they may receive school lunches and educational support, and participate in extracurricular activities.

“It’s not appropriate to keep these kids at home while other children, without disabilities, return to school. It’s also not legal,” Dr. Holman says, referring to the Individuals with Disabilities Education Act (IDEA) of 1975, which guarantees that children with disabilities have access to a free and appropriate public education.

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With approximately 14% of the 50.8 million children enrolled in public school in the U.S. in 2019 receiving special education services, this is not a small problem.

The role of the pediatrician

Research shows that the vast majority (85%) of pediatricians feel they should assist parents in obtaining special education services when needed. However, during well-child visits, only 61% of those pediatricians asked parents if they needed help, less than half provided parents with information on community services, and only 13% provided educational material.

To support children with disabilities, pediatricians should ensure that they are in appropriate environments, says Dr. Holman. Pediatricians should make the most of each well-child visit, asking if the child has an Individualized Education Plan (IEP) and going a step further to enquire as to whether parents think that IEP is appropriate.

During the COVID-19 pandemic, especially, they should also ask whether children are partaking in in-person or remote learning, or a hybrid solution. Pediatricians may need to advocate for the child with teachers and administrators, troubleshooting with the school if it isn’t living up to its end of the IEP.

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“Sometimes, just asking the question is helpful. Most schools still respond to a doctor’s note that encourages the school to do right by the child,” Dr. Holman explains.

Concerns about the 2020-2021 academic year for students with disabilities

“I’m concerned that the access to — and utility of — technology is not equitable for children with disabilities. A child with internet access who can see, hear and move well is going to have an easier time with online learning than a child with disabilities. Additionally, many kids with disabilities need one-on-one instruction or an aide for things like note taking or test taking. Many parents are unable to provide that level of support. Of note, many of these children only receive therapy through schools, especially in rural areas. We may need to help identify alternative therapeutic options,” says Dr. Holman.

“I also obviously have concerns about infection in in-person settings. There’s a risk to the children, as well as the caregivers who work in close contact with them. I recommend that these aides wear face masks and face shields or other eye protection. Children should also wear masks as they are able. ”

Dr. Holman believes well-child checks should be prioritized for children with disabilities, and that pediatric practices with care coordinators should reach out to families they haven’t seen in a while. “Children with disabilities have a higher incidence of abuse and tend to develop more medical complications when they haven’t in the system,” she says.