SEVERE AND MULTIPLE DISABILITIES

Michael F. Giangreco
The University of Vermont
and
Martha E. Snell
The University of Virginia

Abstract

1. The educational outcomes for children with severe disabilities parallel those for children without disabilities, although there may be differences in the ways they are operationalized, the path to their attainment, and the supports they require.
   
   
2. A rapidly expanding body of published research and demonstration indicates that, to varying extents, all of the educational outcomes parents said they valued are being realized for some students with severe disabilities; the reality is that these outcomes are still not widely available to most students with severe disabilities.
   
   
3. Over the past five years, significant strides have been made in articulating educational models and standards of quality education for students with severe disabilities.
   
   
4. Barriers include (a) educational placement based on categorical label (e.g., severe disability), (b) funding disincentives for general education placements, and (c) the dual system of general education and special education. These three factors threaten students' right to an appropriate education in the least restrictive environment and simultaneously their opportunity to achieve valued life outcomes sought through education.
   
   
5. Actions needed by Congress center upon (a) removing disincentives to the right to attend general education classes in neighborhood schools, (b) preparing personnel to teach students with disabilities in general education classes in neighborhood schools, and (c) improving transition from school to adult life.
   
   
6. Recommendations for improving IDEA's implementation over the next five years through federally funded activities center upon (a) removing disincentives to the right to attend general education classes in neighborhood schools, (b) preparing personnel to teach students with disabilities in general education classes in neighborhood schools, and (c) improving transition from school to adult life.
   
   
7. Recommendations for improving IDEA's implementation by state and local educational agencies center upon (a) state departments of education recruiting statewide input from parents and advocacy groups, educators, and community agencies for adult services, (b) designing priorities for action based on field-based input, and (c) coordinating these activities with related state departments (vocational rehabilitation and adult services).

1. What outcomes within the categorical area are recognized as important for students to obtain?

Parents have reminded us that the educational outcomes sought for their children with severe disabilities parallel those for their children without disabilities, although the ways they are operationalized, the path to their attainment, and the supports they require may be different. Some of these important educational outcomes include (a) being safe and healthy; (b) having a home where they can live now and in the future (e.g., with a family or friends; supported apartment); (c) having friends and other personally meaningful social relationships; (d) having access to a variety of places and activities available to people without disabilities (e.g., general education schools and classes, supported employment, community facilities/activities); (e) using communication and self-advocacy to exert choice and control that match their ages and cultural contexts; (f) having access to supports and skill development to pursue lifelong learning; (g) pursuing personal growth (e.g., creative outlets); and (h) contributing to their community. When each of these outcomes is adjusted to suit individuals, the effect provides the opportunity for purpose and fulfillment in life; this effect is the reason we educate all of our children (Dennis, Williams, Giangreco, & Cloninger, 1993).

2. To what extent have these outcomes been achieved in the last five years?

The differential interpretation and application of IDEA has led to a situation that is simultaneously hopeful and grim. The hopeful perspective reflects a rapidly expanding body of published research and demonstration indicating that, to varying extents, all of the educational outcomes parents said they valued are being realized for some students with severe disabilities. Evidence exists highlighting successful school inclusion, supported employment efforts, development of social relationships, communication and technology advancements, and community-based participation (Meyer, Peck, & Brown, 1991; Snell, 1993). The grim perspective reflects the reality that these outcomes still are not widely available to most students with severe disabilities, leaving many families frustrated and pessimistic about the future. Despite the protections that exist in IDEA, families typically still struggle to access these outcomes for their children. After years of public education, youth with severe disabilities all too often exit school unemployed, without basic skills, lonely, isolated from peers, and disenfranchised from the larger society.

While the current status of public education for students with severe disabilities is cause for great concern and immediate action, the last five years have given rise to some dramatic shifts in educational experiences, demonstrating positive outcomes once believed to be unattainable are indeed attainable. Some of the most visible changes have resulted from new opportunities students with severe disabilities have had to be educated in regular classrooms with supplemental supports and aides, as provided for in IDEA. When thoughtfully planned and implemented, pursuit of an individually appropriate educational program within a regular class setting has led to positive outcomes for students with severe disabilities, their families, and the professionals who serve them (Giangreco, Dennis, Cloninger, Edelman, & Schattman, 1993; Kozleski & Jackson, 1993; Salisbury, Palombaro, & Hollywood, 1993; York, Vandercook, Macdonald, Heise-Neff, & Caughey, 1992). As one general education teacher said, "I think that (inclusive education) just opens up so many doors and avenues and there are role models there; and there are just so many other things available to them (students with severe disabilities) that wouldn't be available if they were in a room with children who were very similar to themselves" (Giangreco, Dennis, et al., 1993, p. 368)

Research has demonstrated that the presence of students with severe disabilities also can contribute to social and academic benefits for students without disabilities (Giangreco, Edelman, Dennis, & Cloninger, 1993; Peck, Donaldson, & Pezzoli, 1990; Logan et al., in press; Sharpe, York, & Knight, 1994). Although a small set of negative literature about inclusive education exists, predominantly this literature either is speculative rather than data based or is rooted in examples where acceptable quality standards have not been established or maintained. Any approach implemented inappropriately or with low quality is more likely to be the brunt of criticism. In a recent article, six general education teachers from Georgia responded to other peoples' speculations that inclusive education would result in "...nightmares of general educators buckling under the burden of educating students with severe disabilities" (p. 235) with their contrasting experiences that inclusive education was a "...reality of dynamic, synergistic collaboration between general classroom teachers, special education teachers, special and general education paraprofessionals, and all the specialists who support children in special education" (Rankin et al., 1994, p. 235).

3. What educational models/procedures are most effective for achieving these outcomes?

Over the past five years, significant strides have been made in articulating educational models and standards of quality education for students with severe disabilities (Orelove & Sobsey, 1991; Snell, 1993; Stainback & Stainback, 1992; Thousand, Villa, & Nevin, 1994). The focus has shifted from promising practices that will benefit a particular group of children based on a categorical label (e.g., severe disabilities) to those that more globally will benefit a wider range of students with diverse characteristics. As schools seek standards against which they can evaluate their own status, tools such as the Program Quality Indicators (Meyer & Eichinger, 1994) and the Best Practice Guidelines for Meeting the Needs of All Students in Local Schools (Fox & Williams, 1991) list effective practices at the school district, school building, classroom, and individual student program levels.

Effective Practices at the LEA and School Levels

At the school district and building levels, an important consideration is establishing a climate where individual differences are respected, positive self-esteem is encouraged, high expectations for learning are promoted, and a caring and healthy environment is established. In part, this can be initiated by having a mission statement establishing a school's commitment to valuing diversity, affirming the belief that all children can learn, supporting the needs of students with diverse characteristics in general education classrooms, and outlining a broad-based set of outcomes sought for students as a result of their education. Staff development based on identified needs should support the school's mission. Policies should be established and routinely updated that allow for operationalizing the school mission (e.g., staff assignment, use of support staff, emergency protocols, school conduct code, transportation). Procedures to promote constructive relationships between families and school personnel are crucial, and the use of collaborative teamwork to replace "expert" models of interaction has yielded positive results. Planning for the transition from school to adult life as well as for other transitions (e.g., from early childhood programs to kindergarten; grade to grade) is vital. Transition planning enhances the probability of positive adjustments by students, families, and staff and creates planned opportunities for effective learning conditions to be extended throughout the school and district.

By contrast, special educators' earlier attempts to implement IDEA's least restrictive environment tenets at the individual classroom or student program level without support at the building and district levels were tenuous and could be characterized as "swimming against the current." Well-intentioned parents and teachers made "deals" in an attempt to produce positive outcomes for individual students, only to meet resistance in the broader school community or have their efforts fall apart when there was a change in personnel or setting. We cannot overstate the crucial role played by the implementation of models consistent with IDEA at the school and district levels to the success of individual students.

Effective Practices at the Classroom and Individual Student Levels

At the classroom and individual student program levels some of the same quality indicators are applicable (e.g., positive climate, regular class placement with supports, collaborative teamwork). By the time a student with severe disabilities has been afforded the right to be educated in the least restrictive environment alongside peers who do not have disabilities, the focus of concern changes to the kind of "nitty-gritty" issues about which teachers and parents are concerned.

Students with severe disabilities must have a clearly identified educational program that delineates individually appropriate learning outcomes as well as general supports which allow them to access and participate in the classroom and individually appropriate community-based sites with people who do not have disabilities. Models of assessment and planning are used to identify learning outcomes and supports that are (a) appropriate to the student's chronological age; (b) functional or useful to the student; and (c) suited to the student's needs in current and future integrated environments.

Ensuring that inclusion is meaningful, be it in school, at work, or in the community, is one of the most significant issues faced by school personnel. How does a team adequately include a student with severe disabilities in typically occurring activities when the learning outcomes they are pursuing may be quite different from those of their peers without disabilities? Approaches such as cooperative learning, peer tutoring, creative problem-solving strategies, co-worker support models, and specific curricular and instructional adaptations are effective vehicles for facilitating individualized outcomes through shared activities.

Moreover, models for instruction that encourage teachers to rely on data they collect about student performance are valuable in making appropriate instructional decisions. So too is integrated provision of related and support services, so that services are educationally relevant and necessary, coordinated, based on consensus decision making, and appropriately provided in integrated environments. Integrated services replace earlier approaches that were characterized both by professionally isolated decision making and implementation as well as questionable necessity and educational relevance. Numerous variations exist to assess, plan, implement, evaluate, and adapt curriculum and instruction for students with severe disabilities who are being educated in general education classes (Orelove & Sobsey, 1991; Snell, 1993; Stainback & Stainback, 1992; Thousand, Villa, & Nevin, 1994).

4. What educational models/procedures most inhibit these outcomes?

Educational Placement Based on Categorical Labels Interferes with Positive Outcomes

Numerous existing models and procedures interfere with the attainment of positive outcomes for students with severe disabilities. Labeling and history are two formidable barriers. In far too many American schools the act of labeling a student "severely disabled" is tantamount to a nearly automatic placement in a special education school or classroom, without a hint of consideration for the possibility that such a student could be effectively educated in the same school attended by his or her neighbors and siblings. Many students with severe disabilities have never been given the initial opportunity to be educated in a general education class. How can school personnel make individualized placement determinations to exclude a student with severe disabilities from general education classes if they have never attempted general education placement for that student? Is not every child entitled to that opportunity? In many cases, a discussion never occurs about what supplemental supports and aides would be necessary for a student with severe disabilities to be appropriately included in a general education class, even though this is explicitly commanded by IDEA. This legacy of placement based on categorical labels is in direct opposition to the importance IDEA places on individualization and represents an ongoing and serious threat to the IDEA assurances of appropriate education in the least restrictive environment.

Choices to Accept or Reject Students with Severe Disabilities and Funding Disincentives Threaten Students' Rights to Education in the Least Restrictive Environment

Sometimes, the threats to appropriate education in the least restrictive environment are more subtle. For example, special education teachers across the country who recognize the benefits of inclusive education are approaching their general education counterparts to ask for volunteers who are willing to have a child with severe disabilities in their classroom. While such scenarios are commonplace and may appear benign, they are in fact further evidence that students with severe disabilities are not being afforded the protections they are entitled to under IDEA. The act of requesting a volunteer presumes that the teacher being asked has the right to say "No." Can students with severe disabilities really have reasonable access when, in essence, schools sanction the right to reject them? It is almost inconceivable that such a blatant invitation to accept or reject a student would be extended based on any other individual difference (e.g., gender, race, national origin, religious affiliation); yet when the issue is severe disability, volunteerism and educator discretion are rationalized as ways to not subject general education teachers to students they are unaccustomed to teaching.

Such limitations on students' rights are exacerbated by the presence of segregated options that are attractive to schools because some state funding formulas provide incentives for separate placements and disincentives for general education placements. While recognizing the inherent dangers associated with "inclusion by volunteering," it remains incumbent upon school leaders to place students in general education classes by carefully considering the needs of the student in combination with the characteristics of the classroom teacher (e.g., skills, talents, attitudes) and necessary supports. Although the reality is that initial placements often result from teachers who volunteer, the limitations of this practice highlight the need to extend skill building and appropriate supports to an ever-expanding group of teachers and for establishing the presence of students with disabilities in general education classrooms as an expectation rather than an option teachers can chose to accept or reject.

The Dual System of General Education and Special Education Interferes with Appropriate Education

Because people with severe disabilities historically have been segregated, many professionals and community members may have negative attitudes about the possibility of including them in general education classes. This is often rooted in the basis of prejudice, ignorance, and lack of ongoing and meaningful interactions. The dual system (special education and general education) of teacher preparation, schooling, and in-service training has perpetuated the myth that general educators are not capable of educating students with severe disabilities. Although general educators will need some specialized supports, increasingly people are recognizing that the characteristics that make for a good teacher are the same regardless of the labels one attaches to students. The dual system of general vs. special personnel preparation has failed to equip all teachers and support staff with the collaborative skills they need to work together to solve the challenges presented by students with a wide variety of characteristics. The heated debates that occur regarding placement options sometimes obscure the importance of considering special education as a supportive service where special and general education personnel work together with students and families, not as location where students must go in order to receive services.

Recommendations for Improving IDEA

The following three sections include recommendations to either amend IDEA or improve its implementation in its current form. These recommendations recognize that IDEA, as currently written, is a valuable and important piece of legislation safeguarding the rights of students with disabilities to receive a free appropriate public education in the least restrictive environment. The fact that outcomes for students with severe disabilities continue to be inadequate and only available situationally is more a function of IDEA not being enforced consistently across the country than inherent problems in the law itself. If IDEA were actually implemented in a consistent manner congruent with its founding tenets and existing procedures, many of the educational problems that currently exist for students with severe disabilities, their families, and service providers would be lessened dramatically.

5. Provide two or three recommendations for action by Congress.

Remove Disincentives to the Right to Attend General Education Classes in Neighborhood Schools While Receiving Individualized Supports from Special Education

First, Congress should direct state educational agencies to examine their certifying standards and requirements and reduce the barriers to including students with severe disabilities in general education classes in neighborhood schools, preschools, and day care settings, while maintaining or improving the specialized services given by teachers of students with severe disabilities.

IDEA's current categorically based funding provisions create incentives for restrictive special education placements and may encourage the overidentification of children with disabilities (Parrish, 1994). Financing policies are needed that (a) guarantee accessible services, (b) ensure accountability, and (c) allow the flexibility needed to serve children with all types of disabilities in the least restrictive environment (McLaughlin & Warren, 1992). Therefore, Congress should amend the funding provisions in IDEA, Part B, Subchapters I and II, from the categorical identification of children requiring special education services up to the 12 percent federal cap to population-based funding with "hold harmless" provisions, so no state will get less than did under categorical funding.

Congress should amend Subchapters I, II, and VIII to require state educational agencies to (a) study their current funding policies in regard to their impact on restrictive placements and relationship to their special education program objectives and (b) if needed, to explore alternative funding mechanisms consistent with providing appropriate education in less restrictive environments. The movement toward noncategorical funding systems such as exist in Massachusetts, Oregon, and Pennsylvania needs to be evaluated to see if they result in proposed benefits. Recent or pending changes in special education funding systems in 47 states, along with the recently adopted national agenda for general education offered by Goals 2000: Educate America Act and special education (COSMOS, Inc., 1994), provide a rare "window of opportunity" for finance reform in special education (Center for Special Education Finance, 1994) and for ensuring congruence between general and special education policy and practice at the federal level.

Prepare Personnel to Teach Students with Severe Disabilities in General Education Classes in Neighborhood Schools

Congress should amend Subchapter IV, Parts B and H, so that funding for special education personnel preparation programs at universities and colleges is provided only to programs that require special education personnel to have practicum experiences in general education classrooms or integrated preschools and day care settings. These must be settings where children with disabilities are appropriately supported alongside their peers without disabilities, and where there are opportunities to learn and use collaborative and problem-solving skills with general educators and families. Special education personnel include not only special education teachers, but administrators, teachers of hearing and visually impaired students, adapted physical education teachers, and related service providers such as speech/language pathologists, orientation/mobility specialists, occupational therapists, and physical therapists.

To this end, Congress and the Department of Education should replace the phrase "multidisciplinary team or group" with the phrase "collaborative team" (see, e.g., 34 C.F.R. § 300.532(e)). This recommendation is based on the professional literature which suggests that "multidisciplinary teamwork" is a contradiction in terms. Merely bringing together a group of people from various disciplines to evaluate, plan, and implement an IEP for a student does not ensure that these various adults will function as a team by collaborating, coordinating, and pursuing shared goals; such features of collaborative teamwork are crucial to successful special education.

Also, Congress should earmark additional funds for traineeships so special education personnel can update their skills to enable them to work effectively in a collaborative manner with personnel from a variety of disciplines within inclusive general education schools, preschools, and day care settings. Additionally, Congress can direct the U.S. Department of Education that the preparation of general education teachers and administrators (e.g., principals, superintendents) must also include opportunities to teach students with a range of disabilities who are meaningfully included and supported in general education classrooms as well as opportunities to work collaboratively with special education personnel in an effort to improve education for all students. Finally, Congress should call for OSERS to adopt as policy the presence of these practicum standards in all federally funded personnel preparation projects.

Improve the Transition from School to Adult Life

Improvements in the transition components of IDEA could have far-reaching benefits for adults with severe disabilities as well as long-term cost savings to society. To date, persons with severe disabilities have had limited access to the type and extent of supported employment opportunities more typically available to persons with mild mental retardation. The daytime and vocational options for adults with severe disabilities all too often are characterized by low or no pay and are limited to segregated options. Supported employment for persons with severe disabilities has been hampered by lack of funding and by professionals inadequately involving parents in transition planning, resulting in families having limited knowledge of post-school options (Gallivan-Fenlon, 1994; West, Revell, & Wehman, 1992). These problems may be reduced as states broaden their fund source utilization under the Rehabilitation Act amendments of 1986 and as supported employment continues to be integrated into states' vocational rehabilitation systems (Sale, Revell, West, & Kregel, 1992). Accomplishment of successful school to adult life transition depends upon several factors such as (a) retaining the IDEA requirement that transition plans be part of the IEP beginning no later than age 16 and annually thereafter (or when appropriate at age 14 or younger) and that adult vocational agencies participate in this planning; (b) strengthening family and student involvement in planning for transition; and (c) requiring that collaboration among Individual Transition Planning Team members (school personnel, family and student, adult service agency personnel) be the primary vehicle for creating, implementing, and evaluating a student's individual transition plan.

Therefore, Congress should amend Part B in the following ways: (a) provide outreach training (Subchapter III) and materials (Subchapters III and VII) for families on the transition-to-work process along with understandable descriptions and illustrations of adult options and directions to access them through the Individual Transition Planning Team; and (b) teach families, school staff, and adult services staff collaborative teamwork and problem-solving skills (Subchapter III). Subchapter V can authorize additional monies to fund an expansion of research and demonstration projects regarding transition from school to adult life.

Because pervasive inequities exist in transition planning and adult options for people with severe disabilities from state to state (Sale et al., 1992) and because there is a relationship between transition planning in high schools and actual outcomes (Gallivan-Fenlon, 1994), Congress must send a clear message to OSERS to strengthen its monitoring of state programs and annual plans related to the aforementioned transition issues. Finally, Congress should conduct oversight hearings to address the inequities between states in their school-to-work transition programs under IDEA and the related use of supported employment funds under the Vocational Rehabilitation Act of 1986.

6. Provide two or three specific recommendations for improving IDEA's implementation through federally funded activities, including but not limited to monitoring, technical assistance, personnel preparation, demonstration, and research, to be carried out over the next five years.

Remove Disincentives to Inclusive Schooling

OSERS must continue to monitor the ways in which states make special education placements as well as their actual placement records, awarding federal funds contingent upon compliance with IDEA and the correction of identified problems. Furthermore, OSERS should monitor states' funding systems in special education in an effort to identify any fiscal incentive for restrictive placements that run contrary to the LRE (least restrictive environment) tenets of IDEA. OSERS should adopt as agency policy the requirement that all funded state education agency special education plans set goals, consistent with monitoring results, for achieving nonrestrictive placements and provide documentation for meeting those goals. The procedures for monitoring and state-initiated improvements should include assessing the incentives and disincentives in each state's system by describing its processes and measuring its outcomes such as numbers of students in special education classes and schools.

To assist in achieving long-term reform in state fiscal systems, OSERS should provide financial support and technical assistance to states as they reform their funding systems in ways that foster less restrictive placements and more flexibility in the use of funds such as the provision of unified services across categorical groupings (McLaughlin & Warren, 1992). In addition, OSERS should (a) fund research on the development of alternative funding systems for SEAs which eliminate incentives for segregated placements; (b) fund training projects (e.g., statewide systems change projects and model demonstration sites) to establish inclusive school programs which have compatible fiscal policies; (c) require that OSERS offer grants for personnel preparation, clearinghouses, and traineeships in special education finance as well as require that leadership and administrator training programs in special education include comprehensive and current coverage of this topic; and (d) require state plans to report the extent to which their funding systems achieve the goals of less restrictive placements with more flexibility and accountability. Finally, OSERS should direct state educational agencies to examine the relationship between the teacher certification procedures in special education (e.g., categorical, cross-categorical) and their record on educational placements in an effort to determine the extent to which certification standards are inhibiting or facilitating educational placements in the least restrictive environment.

Prepare Personnel to Teach Students with Severe Disabilities in Neighborhood Schools

OSERS should adopt an agency policy requiring all funded personnel preparation programs to have practicum experiences in inclusive schools and training in collaborative teamwork and problem-solving methods to support students with special educational needs in general education classes, integrated preschools, and other environments (e.g., community, vocational) with people who do not have disabilities. Furthermore, personnel preparation applications for training teachers of students with severe disabilities should meet additional standards in content and outcomes that reflect the most current promising and effective practices. Additionally, any funding awards for personnel preparation of general education teachers or administrators would reflect Congress' insistence on the importance of experiences in inclusive schools and training in collaborative teamwork and problem-solving methods to support students with special educational needs in general education classes. OSERS should direct state educational agencies to design state plans that address personnel shortages in ways that are both consistent with the quality standards and allow more flexibility in supporting students cross-categorically.

Improve the Transition from School to Adult Life

While OSERS must continue to monitor state plans and performance in transition planning, OSERS should request that states report annual follow-up data on the employment of graduates from special education programs and set goals for improvement. OSERS should request that state educational agencies work cooperatively with state vocational rehabilitation agencies to obtain these data and to set these goals. In addition to these cooperative follow-up efforts across state agencies concerned with transition of students with disabilities from school to work, OSERS should fund demonstration projects which would require state departments to work together to align their transition policies from IDEA and the Vocational Rehabilitation Act so that the transition process is "seamless" across agencies and "user friendly" for families and educators. Through these demonstration projects, state educational agencies and vocational rehabilitation agencies would gather consumers and local school and adult services staff together to examine the barriers to integrated work placements, pay and benefits, and long-term employment. Together their task would be to develop strategies to rectify identified problems. These projects would be required to develop training materials for families, school staff, adult services staff, and potential employers as well as develop model programs for school to work transition which use collaborative teamwork and problem-solving methods.

7. Provide two or three specific recommendations for improving IDEA's implementation by state and local education agencies.

Using state educational agencies funds, private agencies, specially appointed panels, or University Affiliated Programs should hold regional focus groups on the barriers to quality educational programs under IDEA for students with severe disabilities and explore potential solutions. Groups should include families, educators, community agencies, advocacy groups, and local political leaders. These groups would focus on such topics as (a) inclusive neighborhood schools, (b) personnel preparation, (c) transition from school to work, and (d) humane and effective approaches to serious behavior problems. The findings and recommendations from these groups would be used to develop agency agenda, address planning and improve services under IDEA at the state and local levels, determine training needs for school and agency staff, develop dissemination sites, and validate state monitoring procedures.

State educational agencies and local education agencies should explore with their family resource centers and advocacy groups ways to improve the interactions between schools and families. Because collaborative teamwork and problem-solving skills are critical across so many promising and effective practices in special education and frequently represent the weak link in the application of those practices, state educational agencies can fund training projects that address collaborative teamwork and problem-solving methods among families, special and general education personnel, and other related agency personnel. Through their capacity to monitor IDEA implementation, provide technical assistance, oversee teacher certification, and fund research and training projects, state educational agencies should communicate to local education agencies the importance of building collaborative teamwork and problem-solving skills and procedures into their routines, both to develop IEPs and ITPs and also as part of the day-to-day operations in schools. State educational agencies should require that institutions of higher education address collaborative teamwork and problem-solving skills in all teacher, school administrator, and related service (e.g., speech/language pathology, social work) programs and should work with state health agencies to include such training in programs for allied health professionals such as occupational and physical therapists. State educational agencies, in cooperation with adult service agencies, should not only examine state regulations in terms of accuracy and consistency across agencies but also explore training certifications in areas of transition from school to work.

References

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COSMOS, Inc. (1994, June). National agenda for achieving better results for children and youth with disabilities. Washington, DC: Author.

Dennis, R., Williams, W., Giangreco, M. F., & Cloninger, C. (1993). Quality of life as a context for planning and evaluation of services for people with disabilities. Exceptional Children, 59(6), 499-512.

Fox, T., & Williams, W. (1991). Best practice guidelines for meeting the needs of all students in local schools. Burlington, VT: University of Vermont, College of Education.

Gallivan-Fenlon, A. (1994). "Their senior year": Family and service provider perspectives on the transition from school to adult life for young adults with disabilities. The Journal of the Association for Persons with Severe Handicaps, 19, 11-23.

Giangreco, M. F., Dennis, R., Cloninger, C., Edelman, S., & Schattman, R. (1993). "I've counted Jon": Transformational experiences of teachers educating students with disabilities. Exceptional Children, 59(4), 359-372.

Giangreco, M., Edelman, S., Dennis, R., & Cloninger, C. (1993). My child has a classmate with severe disabilities: What parents of nondisabled children think about full inclusion. Developmental Disabilities Bulletin, 21(1), 77-91.

Goodwin, T. C., & Wurzburg, G. (1993). Educating Peter [Video]. New York: Home Box Office.

Kozleski, E. B., & Jackson, L. (1993). Taylor's story: Full inclusion in her neighborhood elementary school. Exceptionality, 4, 153-175.

Logan, K., Diaz, E., Piperno, M., Rankin, D., MacFarland, A., & Bargamian, K. (in press). A community of learners: How inclusion can benefit all students. Educational Leadership.

McLaughlin, M. J., & Warren, S. H. (1992). Issues and options in restructuring schools and special education programs. College Park, MD: University of Maryland and Westat, Inc.

Meyer, L., Peck, C., & Brown, L. (1991). Critical issues in the lives of people with severe disabilities. Baltimore, MD: Paul H. Brookes.

Meyer, L., & Eichinger, J. (1994). Program quality indicators (PQI): A checklist of most promising practices in educational programs for students with disabilities (3rd ed.). Syracuse, NY: Syracuse University School of Education.

Orelove, F., & Sobsey, D. (1991). Educating children with multiple disabilities: A transdisciplinary approach. Baltimore, MD: Paul H. Brookes Publishing.

Parrish, T. B. (1994, October). Removing incentives for restrictive placements: Policy paper #4. Palo Alto, CA: Center for Special Education Finance.

Peck, C., Donaldson, J., & Pezzoli, M. (1990). Some benefits nonhandicapped adolescents perceive for themselves from their social relationships with peers who have severe handicaps. Journal of the Association for Persons with Severe Handicaps, 15(4), 241-249.

Rankin, D., Hallick, A., Ban, S., Hartley, P., Bost, C., & Uggla, N. (1994). Who's dreaming: A general education perspective on inclusion. Journal of the Association for Persons with Severe Handicaps, 19(3), 235-237.

Sale, P., Revell, W., West, M., & Kregel, J. (1992). Achievements and challenges II: An analysis of 1990 supported employment expenditures. Journal of the Association for Persons with Severe Handicaps, 17, 236-246.

Salisbury, C., Palombaro, M., & Hollywood, T. (1993). On the nature and change of an inclusive elementary school. Journal of the Association for Persons with Severe Handicaps, 18(2), 75-84.

Sharpe, M., York, J., & Knight, J. (1994). Effects of inclusion on the academic performance of classmates without disabilities: A preliminary study. Remedial and Special Education, 15(5), 281-287.

Snell, M. E. (1993). Instruction of students severe disabilities (4th ed.). Columbus, OH: Merrill Prentice Hall.

Stainback, S., & Stainback, W. (1992). Curriculum considerations in inclusive classrooms: Facilitating learning for all students. Baltimore, MD: Paul H. Brookes.

Thousand, J., Villa, R., & Nevin, A. (1994). Creativity and collaborative learning: A practical guide to empowering students and teachers. Baltimore, MD: Paul H. Brookes.

West, M., Revell, W. G., & Wehman, P. (1992). Achievements and Challenges I: A five-year report on consumer and system outcomes from the supported employment initiative. Journal of the Association for Persons with Severe Handicaps, 17, 227-235.

York, J., Vandercook, T., Macdonald, C., Heise-Neff, C., & Caughey, E. (1992). Feedback about integrating middle school students with severe disabilities in general education classes. Exceptional Children, 58(3), 260-269.

Annotated Literature Abstract

Citation

Giangreco, M. F., Dennis, R. E., Cloninger, C. J., Edelman, S. E., & Schattman, R. (1993). "I've counted Jon": Transformational experiences of teachers educating students with disabilities. Exceptional Children, 59(4), 359-372.

Abstract

This article describes the experiences of 19 general education teachers, kindergarten through grade 9, who had a student with severe and multiple disabilities in their general education classrooms. The data presented in the study were based primarily on interviews conducted with the teachers and augmented with the teachers' responses to questionnaires. Fourteen of these certified teachers were women, five were men. Their teaching experience ranged from two to 21 years; 12 of these teachers had eight or more years of experience. Each teacher's classroom was supported by a paraeducator, special educator (part-time), and individually determined related service providers. This study presents important data because it chronicles what happened when students with severe disabilities were actually educated in regular classes rather than merely speculating about it. The article discusses implications for service provision, teacher training, and educational placement. Additionally, it raises issues about why some teachers change and others do not and pressing concerns about whether students with severe disabilities are being afforded their rights to an appropriate education in the least restrictive environment. As the article states, "We contend that educational equity will continue to elude us as long as we apply different standards to students whom we are unaccustomed to teaching" (p. 371).

Key Points and Quotes

1. Teachers' initial reactions to inclusion were cautious, negative, and lacked ownership.

Without exception, the teachers in this study characterized their initial reactions to learning that a student with severe disabilities would be in their class in a cautious or negative manner. They described their feeling with words like "reluctant," "scared," "nervous," "apprehensive," "angry," and "worried" (p. 363). Initially these teachers perceived their role more as a host than a teacher, assuming that someone else (e.g., special educator, paraeducator) would have primary responsibility for educating the child.

2. Teachers reported transformational experiences where they became positive about inclusion based on their interactions with students with severe disabilities and learned ways to be successful in the classroom.

Seventeen of the 19 teachers experienced significant changes in their expectations for ownership of the student's education and, after initial interaction with the student, replaced their negative and cautious reactions with descriptors such as "positive," "good," successful," "interesting," "amazed," "pleased," "great," "wonderful," and "enjoyment" (p. 364). These transformations were gradual and progressive rather than discrete and abrupt and were prompted by reflection on the part of the teachers that they were not sufficiently involved with the student. As one teacher said:

I just realized that he had been in my classroom for a month or so, and I had no contact with him really. I have a student in my classroom and I don't think I have even touched him. You know, I had so much physical contact with all the other first graders, patting them on the back, going up to them and talking to them. Other than saying "Hi Jon" when he came into the room I basically didn't have any contact with him. I started realizing at that point that I have got to have some impact on him. He's one of my students. I always said, "I have 13 students plus Jon," and then I realized: Why am I saying "plus Jon"? He's one of my students. (p. 365)

Teachers who transformed reported an increase in their sense of ownership for the child's education and developed a willingness to (a) interact with the student, (b) learn skills needed to teach the student, and (c) change their attitudes toward the student. As one teacher put it, "Nothing here is so outrageous that I can't learn it." Another commented, "To me he was just one of the kids in the class. I think you really have to have that attitude." Teachers found that they could learn a great deal from the other children in the class.

I started watching my own regular classroom students. They didn't treat him any differently. They went about their business like everything was normal. So I said, "If they can do it, I can do it." He's not getting in their way, they are treating him like everybody else. (p. 366)

Teachers reported favoring approaches that encouraged students to learn together (e.g., cooperative learning, group problem-solving), instruction that was as active and participatory and that was typical rather than the specialized. They felt supported by collaborative teams that had a shared framework and common goals. As one teacher said, "The best support was Arlene (special educator). She was excellent. She checked in every week" (p. 366-367). Others commented, "It's nice to have somebody there," or "I really don't have any concerns knowing that a backup system is in place." (p.367) Although teachers appreciated support personnel, such "supports" were perceived negatively by teachers if they were based on the separate goals of specialists, disrupted the classroom routine (e.g., pull-out services), were overly specialized, and/or did not assist in supporting the students' needs in the regular classroom.

3. Teachers reported benefits to themselves, students with severe disabilities, and classmates without disabilities.

Teachers in this study reported benefits for the students with severe disabilities and their classmates without disabilities, as well as benefits to themselves both personally and professionally. As one teacher said, "I really think it changed the way I teach a lot. I think it was really for the better. I think it made me more flexible." Another offered, "Anything that dramatic has to make you more aware of everybody's needs" (p. 370).

Annotated Literature Abstract

Citation

Gallivan-Fenlon, A. (1994). "Their senior year": Family and service provider perspectives on the transition from school to adult life for young adults with disabilities. The Journal of the Association for Persons with Severe Handicaps, 19, 11-23.

Abstract

The transition process from high school to adult life for 11 young adults with moderate and severe disabilities was studied over a 16-month period. The data consisted mainly of transcribed interviews with transition team members and field notes taken following observations and interviews. Qualitative analyses revealed eight themes which fell into three broad categories, the main points of which are summarized below. This study, which took place before the IDEA requirement that schools develop Individualized Transition Plans (ITPs), illustrates the problems that result from starting too late in a student's school career, not sharing information across the team, minimal participation by parents in the decision-making process, lack of attention to student preferences, and inadequate collaboration among transition team members.

Key Points and Quotes

1. Parents, young adults, school personnel, and adult services providers have differing expectations and aspirations for young adult life.

When asked about their future, young adults expressed a desire to have paid employment and participate in community life in typical young adult ways (e.g., "work at Sansone's department store, hanging up clothes" or "...keeping this job! At the Donut Shop," p. 14). By contrast, many families and service providers have aspirations for these same young adults with disabilities that were lower. As one parent said, "I want the (sheltered) workshop, but she loves Burger World....I really like the workshop, I'd feel safer with her working there" (p. 15). An adult services provider said, "Mark is a long way from working in the community. I think he'll need sheltered employment" (p. 15).

2. While some high school programs include relevant community-based training on jobs, most programs had minimal family involvement, a lack of knowledge sharing and collaboration on ITP teams, and last-minute transition planning.

The 11 young adults and their families infrequently participated in the transition process or in selecting adult options. Families were rarely given information about the services available and were often unassisted by school and adult services staff in the decision-making process. Transition team members from the school and community agencies often knew very little about the services themselves. Adult services staff did not meet the young adults with disabilities until close to graduation, and parents typically never observed their sons and daughters in the community job placements during their high school years.

3. Although six of the 11 young adults were employed in community jobs upon graduation, six months later only two remained employed, with three attending sheltered workshops, one in a day treatment center, and the remaining five "sitting home."

For the brief time following graduation, the young adults talked about the benefits of their community jobs, including the work that they performed, the people they worked with, and the money they earned. But within six months, only two of the six still had jobs in the community, due to the elimination of the jobs and cuts in needed support. The three at sheltered workshops often stayed home due to work shortages at the agency; their pay averaged between $0.27 and $0.90 per hour. These young people, once happy about their community work, expressed dislike of their workshop positions.

4. Findings had significant implications for the school to adult life transition process and ITP team participants.

It is possible that these negative examples of transition may be improved by the substantial provisions regarding transition services currently included in IDEA. However, the author emphasized that several of the findings should be acted upon by school and adult services staff if transitions are to be smooth and based upon the aspirations and individual characteristics of the student. "Families must be provided with necessary information to make informed decisions regarding adulthood" (p. 20). This might mean informal training on the ITP process, visiting young adults with disabilities at community jobs or viewing their activities on videotape, maintaining ongoing communication between families and staff regarding the student's progress, and/or discussions to facilitate expanded understanding of community living, social/recreational opportunities, and person-centered planning approaches.

"The role of the transition coordinator was a pivotal one not readily accepted by those fulfilling it" (p. 21). Individuals in these roles must have the information about adult services and the transition process, must share information, and must know how to facilitate planning by the transition team. There was a "lack of collaboration that occurred among transition teams...and confirm(s) the necessity of effective teaming in the transition process" (p. 21). "Most services for adults with disabilities continue to be segregated, encourage life-long dependency, and offer limited opportunities to participate in community life in typical adult ways" (p. 22). The supports needed for individuals are most accurately determined by a team of family members, friends, advocates, and service providers. Funding for adult services should be targeted to the people receiving them, not to "programs." Flexibility in designing one's supports is far better than having to choose from "a continuum of existing services" (p. 22). Supported employment funds should be reserved for persons with severe disabilities who need them.

Model Profile

Kipps Elementary School is one of 13 elementary schools in the Montgomery County Public School Division in the southwestern part of Virginia. Kipps is a new school which opened in the fall of 1994. The principal, Ray VanDyke, and several of the current teachers transferred from nearby Gilbert-Linkous Elementary School, filming site for the award-winning videotape, Educating Peter (Goodwin & Wurzburg, 1993). At Kipps, like other schools in the system, students with disabilities attend general education classes in their neighborhood schools with their peers who do not have disability labels. Principals and staff in each school are involved in shared decision-making teams whereby decisions about the school's resources are made cooperatively with staff and with the input of parents; these decisions are consistent with the schools' and district's philosophy of providing special education services in the least restrictive environment with the neighborhood school. The special education services and supports needed for each student are planned collaboratively by the student's educational team to address the individual student's strengths and needs; supports are implemented, evaluated, and revised by the team on an individual basis, not prescribed by a disability category. Collaboration between the special education teachers, classroom teachers, parents, and other team members (e.g., related services personnel) provides the essential mechanism for planning and problem-solving.

Most elementary schools in this system have included students with mild disabilities for the past five or six years, while students with more severe disabilities have been included for the past three to four years. Special education and related services are provided to these children in general education classrooms appropriate to their chronological age. The general class teachers regularly collaborate with these special education personnel to plan needed adaptations. They may also have a reduced class size and assistance from a paraprofessional. Prior to the implementation of inclusion in this school system, in-service training on inclusive philosophy and methods was conducted and visits were arranged to other school systems that were using inclusive educational practices. Inclusion began with preschoolers and elementary-aged students with disabilities and gradually has been extended across all elementary schools and into the middle and high schools.

At Kipps, Benjamin is one of 10 students with severe disabilities, each of whom is enrolled full-time in a general education classroom. These students range from 5 to 11 years old and are placed in kindergarten through grade 5. These students have special education labels such as "multi-handicapped," "developmental delay," "autism," and "mental retardation" and have one or more of the following conditions or characteristics: cerebral palsy, visual impairment, Down syndrome, challenging behavior, and nonsymbolic communication.

Benjamin's first year of inclusive education was in preschool within Head Start. He is now seven years old and in Tricia William's second grade classroom with others his age. Benjamin has cerebral palsy, moves about with a walker, and has a special education label of multiple handicaps. He has developmental delays, visual impairments, and speech and language impairments, and hydrocephalus. He communicates primarily by words and phrases, gestures, and facial expressions. Benjamin, who is well known for being highly social, is described by some of his classmates as being "a very popular kid."

Benjamin's classroom has the same number of students as other classrooms in the school but is assigned one teaching assistant in the morning, who alternates with another in the afternoon. Both assistants attend to special needs presented by Benjamin, assist with general classroom activities, and also support educational needs of other students who do not have disability labels. By dividing their time across two different classrooms, these assistants develop more versatile skills, and capacity is created within the school that minimizes the disruption caused by the inevitable absence of the teachers or assistants. Benjamin's special education teacher, Kenna Colley, distributes her time among the classrooms at Kipps where the 10 students with severe disabilities on her "caseload" are placed by working with the classroom teachers, teaching assistants, related services personnel, and peers. Through this collaboration, Benjamin participates in the same educational activities as his classmates although at times he may be pursuing different learning outcomes than they are and/or he may need individualized adaptations to ensure that his involvement is meaningful (e.g., enlarged print materials, specialized seating, peer assistance).

Benjamin's educational program is oriented toward his participation in school routines with an emphasis on skills needed for communication, peer relationships, mobility, and self-care. Though these represent the focus of his individualized curriculum, he is exposed to a broad array of curricular content in general education areas such as physical education, music, art, science, social studies, and language arts. The related services providers work with classroom staff to provide educationally relevant input that is required to support Benjamin's program in general class and school activities.

The school system uses a planning process to make the transitions from grade to grade and school to school "seamless" and smooth. For Benjamin, this involves his team beginning their discussions about the upcoming school year in March and April. Classroom visitations are part of this process so that the selection of the teacher and classroom can be balanced with the school's overall configuration of students needing special education supports. At this point in the evolution of inclusive education in Montgomery County, teachers are hired with the understanding that children with disabilities will be in their class and that individually determined supports will be provided; thus, seeking teachers who are willing to volunteer to have students with disabilities in their classrooms is not part of the transition process. An effort is made to keep friends together, so last spring when transition planning began, the team made sure that children, including Benjamin, each had a core of friends in his or her upcoming classroom.

Mr. VanDyke established twice monthly "inclusion meetings" devoted to collaborative problem-solving. Teachers share their successes and concerns in a round-robin fashion, and the group makes decisions about solutions, determines who is responsible, and sets timelines. When complex problems arise, Mr. Van Dyke meets with a smaller group of teachers and facilitates solution finding. "Whole school" strategies also result from collaborative problem solving at Kipps. For Benjamin, who is very social and is learning to move more quickly through the school, a whole school strategy was put in place this year by requesting that everyone reduce their socialization with him in the hall, and instead, wait for times when he is not moving through the schools on a schedule. Teachers in turn advised their classes with sensitive explanations of the reasons.

Peer support is central to the inclusive school program in Montgomery County and takes several forms. For example, peers' questions are answered in respectful ways; teachers model appropriate interactions and help to students with disabilities as needed; teachers work with peers to problem-solve and discuss issues of concern (e.g., "How can we help Benjamin participate?"); and cooperative groups and activity-based instruction are frequently used within classroom activities. All staff members at Kipps Elementary School share responsibility for welcoming, including, and educating all the students in the school, including those with severe disabilities.

For more information, contact:

Ray VanDyke, Principal, or
Kenna Colley, Special Education Teacher
2801 Prices Fork Road
Blacksburg, Virginia 24060
Phone: 703-951-5760
FAX: 703-951-5764

AUTISM

Glen Dunlap and Meme Eno-Hieneman
University of South Florida

Abstract

1. Students with autism comprise a heterogeneous group with diverse and significant needs. The general outcomes that may be particularly important for these students involve the development of social comfort and competence, including an ability to communicate with others, and maximum independence in the performance of functional life skills.
   
   
2. Although there are indications of philosophical shifts in the education of students with autism, it is difficult to document substantial improvements in the outcomes for these individuals.
   
   
3. Promising practices in supporting students with autism include (a) educational programs in which placements and curricula are truly individualized, (b) collaborative support networks, (c) communication-based intervention, and (d) programs based on the principle of least restrictive environment opportunities for community participation.
   
   
4. Practices that are impediments in achieving essential educational outcomes consist of (a) segregated and categorical programs, (b) overreliance on specific models of service delivery, and (c) reactive methods of dealing with problem behavior.
   
   
5. Congress should (a) strengthen language associated with the individualization of educational plans and (b) include incentives for SEAs and LEAs to promote diverse least restrictive environment (LRE) practices.
   
   
6. OSERS should (a) develop monitoring systems that provide ongoing support and assistance to promote creative LRE; (b) fund demonstration, implementation, and evaluation efforts that address individualized, comprehensive supports throughout LEAs; (c) fund personnel preparation programs that include partnerships between universities and LEAs and that are integrated across special and regular education; and (d) fund research that focuses on the social development and social functioning of students from childhood through transition.
   
   
7. State and local education agencies should (a) strengthen mechanisms for families to influence educational objectives, placements, and instructional supports; (b) revise funding formula so that dollars are associated with students' needs, rather than categorical programs or placements; and (c) develop improved programs for teacher training and provide funds to evaluate the efficacy of innovations and model practices.

1. What outcomes within the categorical area are recognized as important for students to obtain?

Students with autism should be provided with the opportunities and encouragement necessary to achieve the same general outcomes that are viewed as essential for all students. Schools should prepare students for adult life in the community, including the worlds of work, recreation, domestic functioning, and social interaction. However, the special characteristics of students with autism indicate certain outcomes that require increased emphasis. In particular, educational programs for these individuals should include as objectives the development of social competence and independence in the performance of life skills.

Social competence. Children and adults with autism are distinguished by the pervasive difficulty and discomfort with which they approach social interactions. This is a very broad impediment, affects virtually all of life's endeavors, and is manifested in significant problems in communication, frequent anxiety in social situations, social withdrawal, and the performance of unusual and sometimes disruptive patterns of behavior. Students with autism need to develop competence and comfort in social interactions. To achieve these vital outcomes, students must be taught functional communication skills, they must learn how to control themselves and their circumstances in acceptable ways, and they must be provided with ongoing, supportive experiences in typical settings that require continuing, community-relevant social interactions.

Independence. Students with autism also need to acquire life skills and routines that allow them to function in a manner that is as independent as possible. The curriculum needs to address skills that are relevant to community functioning (Falvey, 1989). But that curricular emphasis is frequently insufficient, because students also need to complete activities without the hovering or continuous prompting provided by teachers and aides. Independent performance of age-appropriate and -relevant activities should be explicit expectations for all students with autism.

2. To what extent have these outcomes been achieved in the last five years?

The essential outcomes having to do with social competence and independence have not been achieved in a significant way in educational programs for students with autism. In general, education agencies are still fostering models that provide secluded, highly structured instruction but that fail to emphasize the students' social lives or opportunities for independent functioning. There are exceptions, of course, and there are some indications that a philosophical shift is occurring toward a greater programmatic appreciation of the crucial outcomes, but at this point there is meager evidence that these outcomes are being achieved.

It will continue to be difficult to address this question in any depth until agencies and researchers provide system-wide and longitudinal data on meaningful outcomes (Meyer & Evans, 1993). One indication may be the extent to which students with autism benefit from placements in regular education settings. For example, recent data in Florida show that the percentage of children with autism who are being educated in regular classes has risen from zero to 7 percent between 1989 and 1993. Although that may be a desirable trend, these data also demonstrate that the overwhelming majority (90 percent) of these students are still being educated in separate classrooms or separate schools, where useful exposure to typical social interactions is highly improbable.

3. What educational models/procedures are most effective for achieving these outcomes?

Promising approaches for educating and supporting children with autism include individualized educational programs, collaborative support networks that include families and professionals from various disciplines, communication-based intervention, and inclusive programs with ongoing opportunities for social interaction and community participation.

Individualized Educational Programs

The abilities and challenges that are characteristic of autism are extremely diverse so it is especially urgent for educators to individualize placements, educational programs, and behavioral supports. Educational programs should address each student's immediate and long-term needs in the variety of contexts in which the student interacts. This approach is exemplified in a number of functional, activity-based, and individualized sequencing models (e.g, Holvoet, Mulligan, Schussler, Lacey, & Guess, 1984) in which educational goals are identified by examining various activities and environments in which the student participates and then by identifying those skills that the student must exhibit to interact successfully in those situations. Individualized support also requires attention to a student's idiosyncratic preferences, learning styles, and patterns of interacting with the environment. Assessing and addressing these aspects of a student's functioning are vitally important for communication development and behavioral support (Carr, Robinson, & Palumbo, 1990).

Collaborative Support Networks

Collaborative support networks involve informal structures created to support a student and to facilitate consistent communication between care and service providers (Nisbet, 1992). Collaborative relationships are characterized by openness, mutual respect, and shared responsibility. Because students with autism usually present a variety of challenging characteristics and because effective support must be provided in a comprehensive and coordinated manner, providing for a collaborative team process to design and implement an educational support plan is regarded increasingly as a feature of exemplary practice.

Communication-Based Intervention

An educational approach that serves to develop forms of practical communication and simultaneously reduce serious problem behaviors is referred to by several labels, including communication-based intervention (Carr et al., 1994) and functional communication training (Durand, 1990). These procedures have extensive support in the research literature and have been demonstrated to be effective with a diversity of students and situations. The approach begins with a process of functional assessment (e.g., Foster-Johnson & Dunlap, 1993) that produces the information needed to design individualized communication programs and other support strategies. The communication skills that are developed serve the same purpose as the problem behaviors, but they do so more effectively and efficiently so that the student has no need to exhibit the problem behavior. As a result, the student benefits from increased communicative competence, decreased rates of undesirable behavior, and, more generally, a positive atmosphere associated with respectful, individualized, and proactive educational procedures.

Inclusive Programs with Opportunities for Community Participation

Children with autism can be educated successfully in inclusive settings if they receive adequate supports. Indeed, if the essential, social competence and independence outcomes are to be realized, it may be necessary to provide inclusive educational programming whenever, and to the fullest extent, possible (Dunlap & Robbins, 1991). Although there is much to be learned about providing inclusive support for students with autism, it is unequivocally clear that social development, in particular, cannot flourish in isolation from peer interactions and typical social relationships. Inclusive programming includes regular class placements with the provision of formal assistance and natural supports (Jorgensen, 1992), as well as opportunities for participation in the curricular and extracurricular activities of the community (Falvey, 1989).

4. What educational models/procedures most inhibit these outcomes?

Program models that may impede progress toward social competence and independence for students with autism, aside from those which are simply negligent, are essentially the antithesis of practices that promote these desirable outcomes. These models and procedures include but are not limited to segregated and categorical programs, highly specific and standardized prescriptions for service delivery, and reactive methods of dealing with problem behavior.

Segregated and Categorical Programs

Center schools and self-contained special education classrooms present barriers to social development, peer interaction (and opportunities for friendships), and the emergence of independence. For children with autism to acquire socially adaptive skills, they must have access to the contexts in which those skills are to be demonstrated. They also must perceive themselves, and be perceived by others, as genuine members of their school community. Segregated, special education programs have long histories of justification, but these are recognized increasingly as being based on administrative convenience rather than student need. There is a great deal that needs to be understood and rearranged before fully inclusive education can benefit all students with autism, but a necessary step is to acknowledge the barriers that are represented by self-contained, categorical, and segregated programs.

Specialized Models of Service Delivery

The history of autism is one in which hundreds of specialized, "expert" models of service delivery have been advanced, exercised, and discarded. Many of these models are based solely on unverified theory or on unreplicated findings that have been promoted as a panacea for autism. A lesson to be acquired from this history is to avoid reliance on a particular orientation and, instead, to develop individualized education plans on a foundation that includes the growing data base of empirical, replicated findings regarding effective educational practices, common sense, devoid of the autism mystique, careful, functional assessment and futures planning, and knowledgeable and caring input from a collaborative team that includes professionals, family, and friends. Overreliance on highly specific models, or dependence on one professional voice, can inhibit progress toward meaningful outcomes for students with autism.

Reactive Methods of Dealing with Problem Behavior

Another impediment to desired outcomes is the common practice of reacting to problem behaviors with punishment procedures that are intended to suppress the unwanted behaviors. Since the 1960s, a popular means for managing difficult behavior has been punishment, and this tradition led to the implementation of many bizarre, cruel, and unnecessary procedures. People with autism have been subjected to harsh punishments quite frequently in schools and other settings. These punishment procedures have been recognized increasingly as ineffective and inhumane. The continued use of reactive techniques can suppress problem behavior temporarily. These techniques, however, can be associated with serious side effects, inhibit communicative expression, and stigmatize and ostracize the students, and they are generally not permitted in inclusive school environments. As a result, behavior management that relies on reactive procedures represents a serious impediment to the achievement of desired outcomes for students with autism. These reactive approaches should be replaced by positive alternatives (Horner et al., 1990), including functional assessment and communication-based interventions (e.g., Carr et al., 1994) that repeatedly have been demonstrated to be effective.

5. Provide two or three specific recommendations for action by Congress.

Congress should contribute to improved educational practices for students with autism by strengthening the language and the oversight that pertain to the individualization of educational plans and by including incentives for SEAs and LEAs to promote diverse, inclusionary practices. Both of these actions would serve the needs of low-incidence groups of students (e.g., students with autism) who present substantial challenges to service systems by encouraging educators to focus on the individual support needs that these students present and, thus, to move away from consolidated, segregated practices.

Including Explicit Directives in the Committee Report Regarding the Individualization of Educational Plans and Programs and Providing for a Similar Focus in Oversight Hearings

A very significant problem affecting educational services for students with autism is the general failure to provide educational plans and programs that are truly individualized. Instead, school systems often operate with a presumption that students who have the label of autism will receive "autism" services in an "autism" classroom, using an "autism" curriculum, under the direction of the system's "autism" teachers. This tendency violates the indispensable condition of individualization, and it also works as an impediment in the movement toward social development and inclusive education. Therefore, it would be helpful if Congress could include in the Committee Report that accompanies IDEA clear, strong language that mandates demonstrable individualization in the education plans, programs, placements, and supports that are provided for all students, including those with autism. To support this emphasis, Congress should focus oversight hearings on this same concern.

Providing Incentives, Through OSERS, for SEAs and LEAs to Promote Diverse, Inclusionary Practices

Congress should direct OSERS to direct discretionary resources that are awarded to state and local education agencies such that they are used to encourage responsivity to individual needs of students who have autism or other low-incidence disabilities. This is a crucial consideration for special and regular education, so it would be desirable for Congress to appropriate additional funds for OSERS to distribute for this purpose, especially through systems change and utilization projects.

6. Provide two or three specific recommendations for improving IDEA's implementation through federally funded activities, including but not limited to monitoring, technical assistance, personnel preparation, demonstration, and research, to be carried out over the next five years.

There are several actions that OSERS should take that will improve the implementation of IDEA and serve students with autism more effectively. In particular, OSERS should develop monitoring systems to provide ongoing support and assistance for creative, inclusionary practices; fund demonstration, implementation, and evaluation efforts that address individualized, comprehensive supports across LEAs; fund personnel preparation programs that include partnerships between universities and LEAs and that are integrated across special and regular education; and fund research that focuses on the social development and social functioning of students from childhood through transition to adult life.

Developing Improved Monitoring Systems

OSERS should develop monitoring systems to avoid the "one-shot" evaluations and, instead, offer ongoing consultation and support for states and districts. As school restructuring progresses in various forms in different states, education agencies will need continual guidance, assistance, and monitoring so that the emerging structures incorporate appropriate, systemic responses to the education of students with autism and related disabilities. In particular, this ongoing monitoring will need to encourage creative, inclusive educational opportunities for all students.

Funding Evaluation and Change Projects Across LEAs

OSERS should provide funding for innovative projects within local education agencies. Students with autism will not be served adequately unless the entire local education system is philosophically and programmatically attuned to the need for individualized planning, placement, and support. Therefore, funds would be well directed if they allowed system-wide demonstration, implementation, and evaluation efforts across the spectrum of a local agency's operations.

Funding Integrated Personnel Preparation Programs

OSERS can encourage improvements in teacher (and related personnel) training programs in several ways. First, priorities should be established to fund those university programs that merge special and regular education training and that promote flexibility in certification requirements. Second, funding should depend upon the incorporation of current, appropriate practice rather than outdated educational models and approaches. Third, funding should encourage partnerships between university training programs and local education agencies, such that there is a coordinated push to build effective programs for all students, including students with autism.

Funding Research on the Social Development

Finally, OSERS should fund applied research in the area of social development and social functioning of students with autism. Social development is defined broadly. It includes the growth of communicative competence, friendships, social comfort, and the ability to negotiate the complex social arena in which we people interact. It is especially crucial that this research identify meaningful outcomes and develop an improved understanding of the full social lives of these students so that educational programs can be designed more successfully.

7. Provide two or three specific recommendations for improving IDEA's implementation by state and local education agencies.

The recommendations for OSERS can apply to state initiatives as well but with additions. Specifically, state and local education agencies should strengthen mechanisms for families to influence educational objectives, placements, and instructional supports; revise funding formulae so that dollars are associated with students' needs, rather than programs or placements; and develop improved programs for teacher training and provide funds to evaluate the efficacy of innovations and model practices.

Strengthening Mechanisms for Family Influence

It is difficult to understand the personalities and preferences of many students with autism, and teachers often find these students to be the most challenging in their classes. Parents and other family members, who also face tremendous challenges, are very often the most knowledgeable and sympathetic sources of information. Families also have the greatest investment in the student's education (Powell, Hecimovic, & Christensen, 1992). Therefore, families should be considered as full partners in the design of educational support programs. Unfortunately, many school systems seem to shun this involvement. Mechanisms need to be developed to encourage school systems and families to work together collaboratively. In this regard, state agencies should be models for the local education agencies by including family representatives in the complete process of planning, monitoring, and supporting district activities.

Revising Funding Formulas

State funding formulas for local education agencies are substantial impediments to individualized student placement and support. Frequently, state funding is tied to categorical labels or to placements. These factors need to be revised so that funding is tied to the student (in accordance with support needs) and not to a program, and such that dollars geared to student support can be used flexibly in accordance with the student's individual support plan.

Developing Teacher Training and Innovations

State and, to some extent, local agenices can improve outcomes for students with autism and related disabilities by encouraging training for all teachers in the basic characteristics and support needs of these students. As schools undergo restructuring, there will be an increased need for transdisciplinary teams and generalist support providers who have expertise in curriculum adaptation, behavioral support, and methods for promoting social development. It will be crucial for state and local education agencies to ensure that these personnel are provided with frequent training opportunities because advances in the field of inclusive education are occurring very rapidly.

Finally, state and local agencies should encourage and support innovative programs and demonstration activities that may include single schools or entire districts. The implementation and evaluation of innovative practices will continue to be extremely important as schools across the country seek improved approaches for supporting students with disabilities.

References

Carr, E., Levin, L., McConnachie, G., Carlson, J., Kemp, D., & Smith, C. (1994). Communication-based intervention for problem behavior: A user's guide for producing positive change. Baltimore, MD: Paul H. Brookes.

Carr, E. G., Robinson, S., & Palumbo, L. W. (1990). The wrong issue: Aversive versus nonaversive treatment; The right issue: Functional versus nonfunctional treatment. In A. C. Repp & N. N. Singh (Eds.), Perspectives on the use of aversive and nonaversive interventions for persons with developmental disabilities (pp. 361-379). Sycamore, IL: Sycamore Press.

Dunlap, G., & Robbins, F. R. (1991). Current perspectives in service delivery for young children with autism. Comprehensive Mental Health Care, 1, 177-194.

Durand, V. M. (1990). Functional communication training: An intervention program for severe behavior problems. New York: Guilford Press.

Falvey, M. A. (1989). Community-based curriculum: Instructional strategies for students with severe handicaps. Baltimore, MD: Paul H. Brookes.

Foster-Johnson, L., & Dunlap, G. (1993). Using functional assessment to develop effective, individualized interventions. Teaching Exceptional Children, 25, 44-50.

Holvoet, J., Mulligan, M., Schussler, N., Lacey, L., & Guess, D. (1984). The Kansas Individualized Curriculum Sequencing Model. Portland, OR: A.S.I.E.P. Education Company.

Horner, R. H., Dunlap, G., Koegel, R. L., Carr, E. G., Sailor, W., Anderson, J., Albin, R. W., & O'Neill, R. E. (1990). Toward a technology of "nonaversive" behavioral support. Journal of the Association for Persons with Severe Handicaps, 15, 125-132.

Jorgensen, C. (1992). Natural supports in inclusive schools. In J. Nisbet (Ed.), Natural supports in school, at work, and in the community for people with severe disabilities (pp. 179-215). Baltimore, MD: Paul H. Brookes.

Meyer, L. H., & Evans, I. M. (1993). Science and practice in behavioral intervention: Meaningful outcomes, research validity, and usable knowledge. Journal of the Association for Persons with Severe Handicaps, 18, 224-234.

Nisbet, J. (Ed.) (1992). Natural supports in school, at work, and in the community for people with severe disabilities. Baltimore, MD: Paul H. Brookes.

Powell, T. H., Hecimovic, A., & Christensen, L. (1992). Meeting the unique needs of families. In D. E. Berkell (Ed.), Autism: Identification, education and treatment (pp. 187-224). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.

Annotated Literature Abstract

Citation

Carr, E., Levin, L., McConnachie, G., Carlson, J., Kemp, D., & Smith, C. (1994). Communication-based intervention for problem behavior: A user's guide for producing positive change. Baltimore, MD: Paul H. Brookes.

Abstract

This text describes a systematic, communication-based approach for assessing and intervening with challenging behavior exhibited by individuals with disabilities. This "user's guide" provides a synthesis of the research and commonsense practices. It also articulates values emphasized in supporting individuals with severe disabilities.

Key Points and Quotes

1. Communication-based intervention involves providing a person with alternative, socially acceptable skills to meet the function of, and replace, challenging behavior.

"Communication-based intervention refers to an approach that reduces or eliminates problem behavior by teaching an individual specific forms of communication. Because the communication forms that are taught are more effective ways of influencing others than the problem behavior, they eventually replace the problem behavior itself." (p. 3)

2. Support for individuals who exhibit challenging behavior requires a comprehensive and systematic approach.

"Problem behavior usually serves a purpose for the person displaying it."

"Functional assessment is used to identify the purpose of problem behavior."

"The goal of intervention is education, not simply behavior reduction."

"Problem behavior typically serves many purposes and therefore requires many interventions."

"Intervention involves changing social systems, not individuals."

"Lifestyle change is the ultimate goal of intervention."

(Major Themes, pp. 4-5)

Annotated Literature Abstract

Citation

Jorgensen, C. (1992). Natural supports in inclusive schools. In J. Nisbet (Ed.), Natural supports in school, at work, and in the community for people with severe disabilities (pp. 179-215). Baltimore, MD: Paul H. Brookes.

Abstract

Providing natural supports in inclusive educational programs requires a coordination of social and material resources in an effort to help children with disabilities to develop skills and friendships in mainstream environments. It requires a caring and supportive climate, as well as instructional techniques that promote not only individual achievement, but also collaborative efforts between students and adults.

Key Points and Quotes

1. Natural supports extend beyond the material resources and specific strategies used to support children. They also reflect the philosophy and social ecology of the school.

"Natural supports for school-age children with disabilities are those components of an educational program--philosophy, policies, people, materials, and technology, and curricula--that are used to enable all students to be fully participating members of regular classroom, school and community life. Natural supports bring children closer together as learning partners rather than isolating them." (p. 183)

2. Schools that embrace a commitment to inclusive education are characterized by individualization and collaboration for both the students and instructional personnel.

"Inclusive schools have been described as schools in which: 1) the importance and value of diversity are shown through the entire school culture, 2) the curriculum is designed with all students' needs in mind, 3) instructional models and strategies are based on cooperative principles, 4) staff engage in collaborative interactions to solve problems and carry out instruction, and 5) friendships are intentionally facilitated (Stainback & Stainback, 1990; Stainback, Stainback, & Forest, 1989). An additional characteristic of inclusive schools is a reliance on natural supports for children with extraordinary challenges; increasingly, this is being recognized as an important factor in making full inclusion successful." (p. 186)

3. Instructional formats that incorporate individualization of learning goals and activities, cooperative learning strategies, and natural peer and adult supports may facilitate student success within inclusive educational programs.

"Even when the curriculum is broad enough to include students who are working on an eclectic array of skills, teachers still need instructional formats that enable them to structure the school day so that every student is spending time actively engaged in learning, and that enable teachers to document individual and group progress toward learning goals." (p. 188)

Model Profile

Today's criteria of best practice for students with autism differ from the criteria of a few years ago, and it is expected that the most effective models will continue to be improved with accumulating data and experience. The local model highlighted in this presentation, in fact, represents a direct advancement from a predecessor that was operated less than ten years ago in Appalachia (Dunlap, Robbins, Morelli, & Dollman, 1988), and it continues to be refined. The best practice model of support for students with autism is a comprehensive early intervention project, funded by OSERS, and operated in the greater Tampa Bay area of west Florida (Dunlap & Fox, in press).

The model program, the "Individualized Support Program (ISP)," is based on a conceptual and values-based orientation that incorporates essential features of current best practice for young children with autism and related disabilities. Although ISP is an early intervention program, these features have relevance for other autism programs because they reflect objectives and programmatic components of general pertinence and importance. The essential features of the model are a distinct individualization, with all plans and interventions being based on comprehensive assessment of the child and his or her environments; a systematic focus on the development of functional communication and social competence; inclusive education and support programs that address useful life skills in typical preschool and child care settings; and an emphasis on family support and participation.

The ISP model is designed to help young children who have severe disabilities in the areas of communication development and behavioral adaptation. Most of the participating children meet the criteria for a diagnosis of autism. The model does not provide direct services but, rather, delivers consultation, training, and individualized support for the children, their families, and the service providers who assume responsibility for the children's care and education. This assistance is provided in the family's home, the community, and in inclusive preschool or day care settings. Because the program is not tied to a specific facility, the catchment area can be extensive and, in this case, it covers the entire Tampa Bay area.

The program is staffed by professionals and paraprofessionals who have expertise in early childhood special education, child development, and optimal support strategies for children with disabilities. Included on the staff are people who have family members with disabilities.

The program is operated for each participant in two general phases:

• Phase 1 is relatively intensive, lasts approximately four months, and includes (a) comprehensive ecological and functional assessments, (b) rapport building with the child and with family members, (c) futures planning and collaborative teaming, (d) comprehensive family support and training, (e) direct interactions with the child to formulate specific intervention strategies, especially in the area of functional communication, (f) identification of appropriate preschool and/or child care programs, (g) training and technical assistance for the preschool and/or child care programs, and (h) transition from intensive support to longitudinal assistance.
  
  
• Phase 2 is an ongoing relationship of support, friendship, and technical assistance. In this phase, the program staff maintain telephone contact and make occasional visits with the family, conduct periodic functional assessments of communicative behavior, provide assistance with transitions and with other difficult circumstances, and, in general, provide professional assistance on an as-needed basis. In Phase 2, the project becomes a back-up support that families and care providers can call upon when a salient change occurs or when additional advice and guidance are requested.

Although the evaluation of ISP is still in progress, initial outcomes with participating children are very encouraging. In addition, the results obtained from thorough evaluations of the earlier model (e.g., Dunlap, Johnson, & Robbins, 1990) demonstrated substantial gains in most areas of development for the majority of participants, including nearly complete elimination of the children's severe problem behaviors.

The general approach demonstrated by the ISP model is applicable for older children with autism and related disabilities. For example, the features of collaborative teaming, communication training, family involvement, and supported inclusion are being used to assist numerous elementary school children who have autism. Unfortunately, these positive illustrations tend to be the exceptions, requiring special efforts of family members and dedicated professionals. Students with autism desperately need these individualized supports to be built into the educational system at all levels.

For further information, contact:

Lise Fox, Ph.D., Project Director, ISP
Department of Child and Family Studies
Florida Mental Health Institute
University of South Florida
13301 Bruce B. Downs Blvd.
Tampa, Florida 33612
Phone: 813-974-4612
FAX: 813- 974-4406

References

Dunlap, G., & Fox, L. (in press). Early intervention and serious problem behaviors: A comprehensive approach. In L. K. Koegel, R. L. Koegel, & G. Dunlap (Eds), Community, school, family, and social inclusion through positive behavioral support. Baltimore, MD: Paul H. Brookes.

Dunlap, G., Johnson, L. F., & Robbins, F. R. (1990). Preventing serious behavior problems through skill development and early intervention. In A. C. Repp & N. N. Singh (Eds.), Current perspectives in the use of nonaversive and aversive interventions with developmentally disabled persons (pp. 273-286). Sycamore, IL: Sycamore Press.

Dunlap, G., Robbins, F. R., Morelli, M. A., & Dollman, C. (1987). Team training for young children with autism: A regional model for service delivery. Journal of the Division for Early Childhood, 12, 147-160.

PHYSICAL DISABILITIES

Sherwood J. Best and Gary A. Best
California State University at Los Angeles

Abstract

1. Special education goals for students with physical disabilities are (a) independent functioning as adults in education, psychosocial, vocational, and leisure activities, (b) participation in academic and other programs, and (c) access to and informed use of assistive technology.
   
   
2. These outcomes have not been satisfactorily achieved, despite IDEA, the Rehabilitation Act, and the Americans with Disabilities Act (ADA).
   
   
3. The promising practices include (a) providing the full continuum of educational placement options, (b) prioritizing student needs as the basis for educational programming, and (c) specialized teacher training.
   
   
4. The barriers include (a) restricting placement options on the basis of the availability of services rather than making placement decisions on the basis of the student's needs, (b) disenfranchising parents so they do not share decision-making powers with educators, (c) insufficient supply of well-trained professionals, and (d) lack of collaboration among teacher training institutions, schools, and other service delivery agencies.
   
   
5. Congress should (a) amend IDEA to include the low-incidence population of students with physical disabilities as a focus category and (b) direct OSERS to provide incentives for teacher training and model demonstration programs.
   
   
6. OSERS should augment (a) personnel preparation programs and (b) model demonstration programs.
   
   
7. State and local agencies should (a) support and maintain the full continuum of educational placement options and (b) collaborate with institutions of higher education in developing more personnel preparation programs.

1. What outcomes within the categorical area are recognized as important for students to obtain?

Students with physical disabilities should attain outcomes that will facilitate their independent functioning as adults in their educational/academic, psychosocial, vocational/transition, and leisure endeavors. In education, they should be able to participate in programs tailored to their individual needs, including core academic, parallel adapted, and functional curricula. Across these options, low and high technologies (including adapted instructional materials, computer interface, and augmentative communication) are critical for their access, participation, and optimal academic achievement (Bigge, 1991).

Positive psychosocial outcomes achieve a congruence between their abilities and the demands of their environments and enhance their personal independence (including mobility enhancement, self-care, and support service coordination), understanding of their own disability status, interpersonal interaction strategies, the establishment of positive relationships, and adaptive communication techniques (Marshak & Seligman, 1993; Powers, Washburn, Parry, Singer, & Sowers, 1994).

Vocational outcomes depend on their adequate career preparation and physical inclusion in the workplace through appropriate access and accommodation as specified in the ADA. Agencies and other services that provide direct and indirect advocacy support are vital assets to their vocational success.

Finally, leisure skills and activities support their independence and functional living. Their knowledge and use of facilities, programs, and activities in a variety of community settings are consistent with their participation in all aspects of post-school social and vocational integration.

2. To what extent have these outcomes been achieved in the last five years?

These outcomes have yet to be satisfactorily achieved, although supported by IDEA, Section 504 of The Rehabilitation Act, and ADA. A major obstacle is a lack of trained teachers to work with students with physical disabilities. Indeed, students' unique educational and psychosocial needs often are not met by skilled teachers (Ammer, Best, & Kulik, 1994). Because of the increasing emphasis on their integration into neighborhood educational programs and because of the expansion of teacher training needs engendered by Part H requirements, this lack is especially critical (Curry & Hatlen, 1989).

The low number of adequately trained teachers stems directly from the small number of teacher preparation programs in the area of physical disability. The trend toward granting more generic credentials in special education, coupled with the low incidence of physical disabilities, does not result in adequate and specialized teacher preparation.

Finally, to support a service delivery system that is practical, "user friendly," and responsive to individual needs, there must be collaboration on services and activities among teacher training institutions, schools, and agencies. Although a knowledge base for training teachers exists, support and dissemination of that knowledge involve a collaborative effort that has yet to be achieved.

3. What educational models/procedures are most effective for achieving these outcomes?

Promising approaches to achieving successful outcomes for students with physical disabilities are (1) providing the full continuum of educational placement options, (2) prioritizing student needs as the basis of educational programming, and (3) specialized teacher training.

Providing the Full Continuum of Educational Placement Options

Students with physical disabilities can have their educational needs met in a wide variety of school placement options. These options fall within IDEA's continuum of placements and include hospitals, home placement, special education day classes, neighborhood schools, and other settings that meet students' needs as identified in their IEPs. The current movement toward inclusion in general education is successful for students with physical disabilities only when support services to meet their physical health care, education/learning, transportation, therapy, medical, and communication needs are provided, as IDEA requires.

Prioritizing Student Needs as the Basis for Educational Programs

The educational needs of students with physical disabilities are diverse and numerous. These needs often are related to the characteristics of a student's disability: neurological or nonneurological conditions; the student's physical stamina; the severity of any particular disability; the multiplicity of disabilities; the level and frequency of medical health care needs; the presence or absence of specific learning and behavioral disabilities; and the student's age, because infant/preschool programs differ in approach in methodology and curriculum from programs at elementary and secondary levels. In addition, appropriate education takes into account individual assessment, use of technology for health maintenance and communication, alternative curricula and teaching methodologies, accessible and modified learning environments (classrooms and buildings), and the availability and promotion of a general education academic curriculum for preparation for independent post-school living. Students' needs related to their physical disabilities and their educational concerns may be met in a variety of settings.

Key to appropriate and successful educational placement of students with physical disabilities is a cadre of specially trained teachers and the availability of a variety of school programs for children. Prospective teachers should be trained to meet students' needs in any of the permissible and appropriate placements.

Enhancing Specialized Teacher Training

Teacher training programs and school placement programs for students with physical disabilities are a "low-incidence" area within special education. Accordingly, teacher training programs and school programs are few in number and must be tailored to meet students' multiple needs. Innovative programs for both teacher training and service provision for these students may need to include new technology for distance-education models, educational resources through interdistrict collaboration, provision of direct medical and education resource materials and personnel at distant on-site locations, and use of the more traditional home-hospital-school site model of service provision.

4. What educational models/procedures most inhibit these outcomes?

It is axiomatic that special education should meet students' individual needs rather than that students' needs should be required or adapted to fit any specific existing or planned program. When students' needs are placed secondary to the characteristic of a specific school program, curriculum, methodology, or school placement, the students and the outcomes of their education likewise become secondary. Two practices that inhibit successful outcomes for students with physical disabilities are (1) restricting educational placement options and (2) parental disenfranchisement.

Restricting Educational Placement Options

It is inappropriate and restrictive to regard as applicable or even desirable a generic special education teacher training program or a single type of educational placement program for students with physical disabilities. The variety and multiplicity of students' needs require a variety and multiplicity of teacher competencies and school placement options. Accordingly, there is no question that the goal of the placement of students with physical disabilities in the least restrictive environment, as guaranteed by IDEA, should be maintained and vigorously supported.

A policy that restricts the delivery of needed educational, medical, and/or health care services to students with physical disabilities meets neither the needs of individual students nor the principles and conditions of IDEA or other rights legislation. To the extent that it is possible and beneficial to meet students' IEP-defined goals and objectives and to provide required health-related care and services, students should be educated in the least restrictive environment with their nondisabled peers. However, a policy that asserts that any model for educational placement is the only viable option can inhibit students' ability to attain identified goals and objectives.

Combating Parental and Student Disenfranchisement

A major provision of the IDEA is the involvement of parents or guardians in the process of identifying and approving of their children's educational goals and objectives. Likewise, the IDEA provides for the involvement of the student, when appropriate, in the IEP process. Parents' and students' direct involvement provides a highly useful level of cooperation and collaboration. Parents and students often have a global awareness of disability characteristics, both limitations and abilities, that may not be shared or even known by school personnel. To disenfranchise parents and students limits educators' abilities to understand and meet students' needs in the classroom or other educational settings and to manage the most appropriate educational placement possible.

5. Provide two or three specific recommendations for action by Congress.

Congress should amend IDEA to specifically support programs for students with physical disabilities and direct OSERS to provide incentives for teacher training and model demonstration programs that address physical disability. These amendments will result in a focus on physical disabilities and affect federal funding activities to enhance teacher competence, in turn leading to better student outcomes.

Supporting Programs for Students with Physical Disabilities

Subchapter III of IDEA identifies specific disabilities (severe emotional disturbance, deaf-blind, severe disabilities, etc.) as critical categories for services. In addition, this subchapter authorizes regional resource centers to promote service delivery. Congress should amend this subchapter to include the low-incidence area of physical disability as a focus category. Specifically, resources for the creation of ongoing regionalization of programs to support local efforts for serving students with physical disabilities will allow collaboration between local education agencies and institutions of higher education. Regionalization of programs enhances educational service delivery to students in urban, suburban, and rural areas. These programs facilitate provision of related and specialized support activities such as itinerant teaching and consultation services, occupational and physical therapies, speech therapy, and other related physical care services.

Directing OSERS to Provide Incentives for Teacher Training and Model Demonstration Programs

Subchapter IV of IDEA authorizes grants for personnel training, and Subchapter V authorizes funded research and model demonstration programs. Incentives in the form of maintenance and enhancement of grant funding of training programs for teachers in physical disabilities and development of model demonstration programs, including regionalization projects, will serve several purposes. First, grant funding provides support to initiate higher education personnel preparation programs in physical disabilities. In addition, grant support of training programs is a powerful inducement for prospective teachers, especially in states where education is a graduate activity and often requires two years' enrollment beyond the baccalaureate degree. Grant support for personnel preparation programs also helps in recruiting and maintaining members of minority communities who are interested in teaching but lack the financial resources to do so. Finally, support for model demonstration programs enhances best practices in both teacher training and education service delivery activities among training institutions, local education agencies, and other service providers.

6. Provide two or three specific recommendations for improving IDEA's implementation through federally funded activities, including but not limited to monitoring, technical assistance, personnel preparation, demonstration, and research, to be carried out in the next five years.

OSERS should provide grant support for personnel preparation programs and model demonstration programs.

Augmenting Personnel Preparation Programs

OSERS should take the following action:

• Establish the area of physical disability as a priority in personnel preparation competitions.
  
  
• Establish priorities for funding teacher training programs in minority institutions of higher education.
  
  
• Provide priority funding for training programs that focus on training personnel to work in the field of early intervention and early childhood special education.
  
  
• Establish funding priorities for programs to train specialists to work in post-school transition programs.
  
  
• Establish priorities to prepare teachers to work in collaborative/ integrated/inclusive educational placement service delivery models.
  
  
• Establish priorities for establishing and implementing teacher training programs through innovative distance education techniques.

Funding Model Demonstration Programs

OSERS also should:

• Establish separate priorities in funding competitions for cooperative program planning and implementation of activities among institutions of higher education, local education agencies, and other service provider agencies.
  
  
• Establish priorities for evaluation research that will identify quality measures of effective school placement program options.
  
  
• Establish priorities for planning and implementing school service delivery programs in rural areas through innovative education techniques.

7. Provide two or three specific recommendations for improving IDEA's implementation by state and local education agencies.

State and local agencies should (a) support and maintain the full continuum of educational service delivery options for students with physical disabilities and (b) collaborate with institutions of higher education that have personnel preparation programs in initiating and conducting field-based research.

Supporting and Maintaining the Full Continuum

State education agencies should encourage educational service delivery options, including general education, itinerant services, special day class, and hospital and home instruction. This can be achieved by attending to teachers' identified unique competencies and students' specific goals and objectives.

State agencies responsible for granting teacher certification and credentials should be encouraged to maintain teacher training programs that prepare teachers to work in school programs for students with physical disabilities. This can be accomplished through the maintenance of special and general education program placement options for all students.

Collaborating with Institutions of Higher Education in Field-Based Research

State education agencies should be identified as a priority concern to Congress by establishing funding for field-based research in special education. These funding priorities should include assistance to design, develop, and implement measures to assess innovative and beneficial school placement options across students' full age and ability ranges.

References

Ammer, J. J., Best, S. J., & Kulik, B. J. (1994). Meeting the needs of students with physical handicaps: A survey of administrators and teachers in California. Physical Disabilities: Education and Related Services, 13(1), 25-39.

Bigge, J. L. (1991). Individuals with physical and multiple disabilities (3rd ed.). Columbus, OH: Charles E. Merrill.

Curry, S. A., & Hatlen, P. H. (1989). Low Incidence Disability Programs Qualities Study: Severely Orthopedically Impaired Version. Sacramento, CA: California State Department of Education.

Marshak, L. E., & Seligman, M. (1993). Counseling persons with physical disabilities: Theoretical and clinical perspectives. Austin, TX: Pro-Ed.

Powers, L., Washburn, L., Parry, B., Singer, G., & Sowers, J. (1994). A student directed model for the promotion of self-determination. (CFDA 84.158K: Model Demonstration Projects to Identify and Teach Skills Necessary for Self-Determination). Lebanon, NH: New Hampshire University Affiliated Programs.

Annotated Literature Abstract

Citation

Swan, W. W., & Sirvis, B. (1992). The CEC common core of knowledge and skills essential for all beginning special education teachers. Teaching Exceptional Children, 25(1), 16-20.

Abstract

This article identifies the outcomes of the work of the Professional Standards and Practice Standing Committee of the Council for Exceptional Children. The committee identified a common core of knowledge and skills necessary for the beginning special education teacher. The article states that (a) there are specific knowledge and sets of skills that special educators in general need to know and (b) there are specialty levels of knowledge and skills "that special educators are to possess in order to teach a particular exceptionality, specialty, or age group." (p. 17)

Key Points and Quotes

1. General and disability-specific knowledge and skills are necessary for beginning special education teachers.

The eight knowledge and skill categories are:

(1) philosophical, historical, and legal foundations of special education;

(2) characteristics of learners;

(3) assessment, diagnosis, and evaluation;

(4) instructional content and practice;

(5) planning and managing the teaching and learning environment;

(6) managing student behavior and social interaction skills;

(7) communication and collaborative partnerships; and

(8) professionalism and ethical practices.

With a combination total of 107 knowledge statements and their associated skills, it is clear that preparation of teachers of students with exceptional needs cannot be considered as "add-on" teacher training. This list provides ample justification for the continuing need for well-trained teachers across several areas of student need and teacher competence.

..."that the knowledge and skills described in the Common Core document will provide guidance to those interested in reforming special education certification standards and enable them to advocate for standards that are professionally sound, reflect best practice, and are universally applicable. The Common Core will need to be improved over time, but for now it is an important step toward strengthening our profession." (p. 17)

Annotated Literature Abstract

Citation

Ammer, J. J., Best, S. J., & Kulik, B. J. (1994). Meeting the needs of students with physical handicaps: A survey of administrators and teachers in California. Physical Disabilities: Education and Related Services, 13,(1), 25-39.

Abstract

A cooperative project, conducted jointly by five universities, which offers credential programs for teachers of individuals with physical disabilities investigated demographics, teacher competencies, and teacher training options. The 220 administrators addressed (a) changing types of service delivery options, (b) increased responsibility of teachers other than those with expertise in physical disabilities to provide for the primary education needs of students with physical disabilities, and (c) continuing need for certified teachers in the area of physical disability. The 143 teachers of students with physical disabilities addressed (a) precredential and postcredential competencies and (b) effective modes of competency training. The study indicates that there is a body of expertise which teachers of individuals with physical disabilities need to learn. Also, special and general educators need to develop competencies to provide primary service for these students in their classrooms.

Key Points and Quotes

1. The diversity of students with physical disabilities necessitates diversity in meeting their educational needs.

Students with physical disabilities are served in a variety of placement options and by teachers whose specific training in this area may be lacking.

• The changing service delivery options produce a critical need for teachers in both self-contained special day classes and in consultant situations.
  
  
• Difficulty in locating properly trained teachers is most pronounced in rural areas.
  
  
• Dual certification to prepare teachers to meet the diverse needs of students was stressed.

"The growing teacher shortage throughout the country is requiring teacher assignment and student placement decisions which are not always based on ideal models of service delivery." (p. 34)

"Where have all the PH (Physically Handicapped) teachers gone?" (p. 35)

2. Teachers must acquire specific competencies to effectively work with students with physical disabilities.

Teachers express a different focus on teacher competencies before and after credentialing. Precredential competencies include knowledge of diverse characteristics of students with physical disabilities, and instructional strategies, and classroom organization/management for multi-needs students.

Postcredential competencies include specialized technology, successful mainstreaming, learning activities and communication systems for nonspeaking students, interfacing special education with core curriculum, infectious disease prevention and practices, and specialized health needs.

"A multi-competency development program of study [is needed] for teachers of students with physical handicaps." (p. 35)

Model Profile

A district-wide program for students with physical disabilities provides an integration approach to academic and social education through a continuum of services for children from birth through high school in the sixth largest school district in the United States. Students are assessed by a multidisciplinary team, and may be recommended for one of several alternative education placements.

Infants are followed in a noncategorical home program emphasizing parental involvement and training. When they are 18-36 months old, they attend school two days per week in a program which focuses on family interaction and socialization skills. Preschool pupils are served in a noncategorical program, in various integrated preschool settings, or at a special education school site. This school contains special day classes for students with intensive needs and houses district-wide therapy services. Interaction between therapists and teachers is emphasized, with the IEP serving as a programmatic base. Efforts are made to integrate therapeutic interventions into the classroom to facilitate generalization of skills and maximize time use. Neighborhood children who do not have disabilities are "reverse mainstreamed" into preschool classes for three hours several times a week to provide positive peer interactions. In addition to a strong academic component, teachers provide training in daily living skills and communication adaptations for students. A wide variety of specialized equipment is available to facilitate independence, mobility, and academic achievement.

Six special day classes serve children attending the school in kindergarten through sixth grade. Each special day class is "partnered" with a general education class located in an adjoining room. Teachers team-teach in the content areas in an atmosphere where specific assistance readily is available. This model utilizes the services of teachers and instructional assistants on behalf of all children.

Throughout this program, the educational team works to determine the readiness of students in special day classes to move to neighborhood school sites. More students with physical disabilities are enrolled in their home schools than are assigned to special school sites.

A unique itinerant program supports inclusion of students with physical disabilities at all age levels. A transportation system is in place that enables students to attend any school in the district. The itinerant team, composed of a teacher, therapist, mobility specialist, and instructional assistant, meets with the parents and personnel of the receiving school to discuss the individual needs of the student. Campus accessibility and student mobility needs and solutions range from the addition of a handrail in a specific area to construction of a sidewalk curb cut and classroom space and structural modifications.

When appropriate, an instructional assistant is assigned to assist the classroom teacher with the physical needs of the student. Training of instructional assistants provides them with the competence necessary to provide the "link" needed by the student and general education classroom teacher for successful integration.

Itinerant team members provide ongoing consultation to school staff and parents to assist in the interpretation of the impact of the student's physical disability on academic outcomes and provide direct support through curriculum modification and use of technology innovations.

At the junior and senior high school levels, students who do not participate in the itinerant program are enrolled in a self-contained special education class at a specified school. Students with physical disabilities may enroll in general education classes and trained staff provide physical assistance and counseling. Computers and adaptive equipment are used extensively in the students' educational programs. Community-based instruction provides students with a curriculum associated with development of independent living skills and appropriate training for the work environment.

The commitment to providing a full range of services, combined with ongoing cooperation and communication among and between parents, students, and members of a multidisciplinary team of school-based personnel, has made education in the least restrictive environment successful for students with physical disabilities in this district. The range of available adaptations and school placements in environments best suited to meet their individually identified strengths and needs reflects the intent of IDEA and the ADA, which support equality of opportunity, full participation, and outcomes of independence and self-sufficiency.

One of the teachers characterized activities in her classroom in the following manner:

I currently have a class of nine students, all of whom have augmentative communication and mobility needs. They need specific training in the use of computers, low-technology picture symbol boards, and high-technology augmentative communication in order to be able to produce school work that reflects their ability. Interactions between the children in my class and the children in the first grade class next door include both academic and social activities. Children interact in small group activities and assist each other throughout the day, which was not possible when our special classes were more isolated. At the same time, however, the children have the benefit of a specially qualified teacher and staff to allow them to develop to the best of their ability.

For more information, contact:

Barbara McNeil, Ph.D.
Program Specialist, Low Incidence Disability Programs
San Diego City Schools
Dana Center
1775 Chatsworth Blvd.
San Diego, California 92107
Phone: 619-225-3776

SPECIAL HEALTH CARE NEEDS

Marilyn Ault
The University of Kansas

Abstract

1. Students with special health care needs should receive instruction on the implementation and management of their particular special health care need within the context of their educational program, receive their education within the least restrictive environment of a general education program, and have the development of the plan for implementation of their special health care needs based upon a family-centered model.
   
   
2. Placement of children and youth requiring special health care procedures remains problematic.
   
   
3. A local education agency adopts promising practices when it (a) allows for collaborative planning, (b) provides sufficient training and monitoring of implementation of the procedures, and (c) supports the least restrictive placement in education.
   
   
4. Educational models that inhibit the desired outcomes are (a) segregated placement options, (b) a centralized system for the delivery of health-related services, and (c) the use of the school nurse or health care professional as direct service staff.
   
   
5. Congress can enhance the educational programs of children with special health care needs by recommending in its Committee Report that (a) the planning and implementation of special health care needs be done within the context of a family-centered approach, (b) the Nurse Practice Acts of individual states allow for the release of nursing skills to sufficiently trained personnel in the schools, and (c) teachers' unions encourage properly trained and monitored teachers to participate in the provision of special health care needs to children and youth within the educational setting as a part of the overall curriculum.
   
   
6. The improvement of IDEA's principle of the least restrictive environment could be facilitated by training programs, at both the preservice and in-service level, which provide teachers with the knowledge and skills necessary to meet the needs of children and youth with a variety of special health care needs.
   
   
7. States could improve the education and inclusion of children and youth with special health care needs by (a) monitoring IEPs to include (i) the instruction of aspects of the health care procedures within the context of the educational program, (ii) the use of a family-centered model in IEP development, and (iii) the implementation of the IEP in an inclusive setting, (b) supporting the use of nurse practitioners as support persons to the overall educational program (rather than direct service providers), and (c) supporting the in-service training of teachers in the area of special health care procedures.

1. What outcomes within the categorical area of special health care needs are recognized as important for the student to obtain?

Students with special health care needs should (l) receive instruction on the implementation and management of their particular special health care need within the context of their educational program, (2) receive their education within the context of a full inclusion program, and (3) have the development of the plan for implementation of their special health care needs based upon a family-centered model.

The first important outcome addresses the need for the instructional program to be designed so the student will learn to be as independent as possible and to fully, or partially, participate with the administration of his or her particular health care procedures. Addressing both the education and health requirement of the student in the educational setting confirms the willingness of the teacher not to compartmentalize the student into the "medical part" and the "education part." The fact that a student has a gastrostomy or a tracheostomy adds to, rather than subtracts from, those aspects of the student's life that may be the content or occasion of instruction. Just as the teacher includes a student's visual or hearing impairment into the identification of the instructional goals and the development of methods for practicing the skill, a teacher must also take into consideration, for example, the student's need for bladder catheterization into the identification of skills the student needs to learn and the method used to practice those skills (Ault, Rues, & Graff, 1994).

The second important outcome is that students receive instruction within the context of an inclusive educational setting. Pediatricians and educators agree that students with special health care needs benefit from inclusion with their peers in regular educational settings (Nader, 1993; Peterson, Barber, & Ault, 1994). Teachers have long seemed willing to meet the needs of the child with special health care needs (Ault, Guess, Struth, & Thompson, 1988); unfortunately, they often attempt to meet these needs without proper training and support. Since teachers remain the primary person responsible for the implementation of special health care procedures in the classroom (Smith & Leatherby, 1992), the issue of training and support is crucial (Burbage, 1992; Nelson, Young, Maurer, & Burt, 1990; Peterson, Barber, & Ault, 1994).

The third desired outcome is that the program outlining the implementation of the special health care procedure be developed in cooperation with the family and other health care providers within the framework of a family-centered model (Shelton, Jeppson, & Johnson, 1992). The provision of special health care procedures must be done in a manner that is culturally sensitive and recognizes the needs and competence of the entire family.

2. To what extent have these outcomes been achieved in the last five years?

The placement of children with special health care needs continues to be problematic. Often children and youth are not allowed full access to typical settings frequented by their peers because staff are ill prepared to meet the students' special health care needs or because of a perceived need to provide a more centralized staffing pattern. There exist many examples of students experiencing limited access to inclusive settings: A mother feeds her child in the classroom at school because staff are not trained to respond to potential aspiration of food and liquids, a student receiving gastrostomy feedings is excluded from typical lunchroom routines, and children attend school for reduced hours because of the inability of staff to reposition correctly and adequately.

A recent study of 50 children and youth identified has having profound disabilities reports that those children with special health care needs tend to be place in segregated, rather than integrated, or inclusive, settings (Siegel-Causey, Rues, Harty, Roberts, Guess, & Ault, 1991). A survey of Iowa schools reported similar findings: 30 percent of children and youth receiving special health care procedures were placed in self-contained classes (Nelson et al., 1990). It may be assumed that the segregated placement is, in part, a function of the extent of the students' special health care needs and the lack of teachers trained in the provision of the procedures within inclusive settings.

Materials are constantly under development in order to provide training for educators dealing with the special health care needs of children. There is a variety of print material available providing direction for training, monitoring implementation of procedures, and safeguards (Graff, Ault, Guess, Taylor, & Thompson, 1990; Haynie, Porter, & Palfrey, 1989; Shelton, Jeppson, & Johnson, 1992; Smith & Leatherby, 1992). A number of videotapes are also available to assist the practitioner in identifying crucial aspects of some specific procedures such as clean intermittent catheterization, positioning and handling, infection control, and feeding strategies (Learner Managed Designs, 1992; Meyer Rehabilitation Institute, 1991 a&b). Unfortunately, these materials primarily present information or outline procedures; they do not offer systematic training or evaluate performance (Lehr & Macurdy, 1994). There is a current need for providing on-site training in the implementation of procedures.

The use of a family-centered approach to the provision of special health care needs is emerging as a model within schools (Graff & Ault, 1993), though its application is more established within medical settings (Leff & Walizer, 1992; Shelton, Jeppson, & Johnson, 1992). The model can be closely associated with the rights of parental participation guaranteed through IDEA. It is unclear, however, how the determination of what health care procedures will be implemented in the schools is made. The family and primary health care provider, as well as the school personnel, should be involved in determining the extent of treatment to be received as well as in training those persons involved in providing special health care within the school setting. While the courts have supported the provision of a variety of special health care procedures within the schools (Department of Education, State of Hawaii, v. Dorr, 1983; Martinez v. School Board of Hillsborough County, Florida, 1988) they have allowed districts to refuse to carry out procedures decided upon by a child's family and primary care physician (VanBiema, 1993; Younger, 1992). A family-centered approach, allowing for participation by all parties involved, should help address potential divisions between the child's health care team and the educational team.

3. What educational models/procedures are most effective for achieving these outcomes?

In order for teachers to be able to incorporate the student's special health care needs into the educational day within an inclusive setting, the school district must (1) allow for collaborative planning, (2) provide sufficient training and monitoring of implementation of the procedures, and (3) support an inclusive model of education.

Collaborative Planning

Collaborative planning for the provision of the student's special health care should occur between the family, special and regular education teachers, school nurse, related service providers, and the student's primary health care provider. Critical components to be identified within the context of the meeting are (l) how and when the special health care procedures will be incorporated into the educational day, (2) who will be the primary and back-up persons responsible for implementing the procedures and instructing the student in his or her participation, (3) who will provide the training and certification of these persons in the implementation of the procedures, (4) scheduling periodic assessments of the key persons' ability to implement the procedures: when and by whom, and (5) an emergency response plan. Additional information should include, for example, protocol, precautions, guidelines for implementation, and possible reactions (Ault, Rues, & Graff, 1994). These meetings should be conducted within the context of a collaborative model in order to ensure the sharing of information and the development of a plan that is complete, safe, and considers the needs of the family and the ability of the teachers (Rainforth, York, & Macdonald, 1992).

Training

Training for the provision of special health care should occur across three major levels (Ault, Graff, & Rues, 1993). There is a general body of knowledge and group of skills that all teachers must have in order to adequately meet the needs of all students. These include infection control, first-aid, and cardiopulmonary resuscitation. There is also a group of procedures that occur at a significantly high enough rate that teachers can be assured that the requirement for these procedures will be present in most, if not all, of the classrooms with which they are involved. These common health care procedures include, for example, seizure monitoring, medication administration, nutrition monitoring, and supplementation. Finally, there are low-incidence procedures that a teacher may or may not be expected to encounter during his or her career. These might include, for example, gastrostomy tube feeding, catheterization, suctioning, or shunt care. All teachers should receive preservice and continuous in-service training on the first category of health care procedures. Training on the other two types of procedures should be determined by their prevalence and be offered in a format that includes general as well as child-specific protocols. Training on child-specific procedures should include both the health care provider and family (Lehr & Macurdy, 1994). Procedures should follow established medical protocols, standard for each procedure. They should also, however, allow for the individual variances and preferences associated with the implementation of a procedure with each person. The family is the key source of information for individual variance. Routine checks on the competency of the educator to implement the procedures should be made by a certified health care provider.

Inclusive Educational Setting

The provision of services should be done within an inclusive educational setting. The American Academy of Pediatrics supports the presumption that children with special health care needs should participate with their peers in school settings (Nader, 1993). Technological advances in both medical procedures and equipment allow for the provision of special health care procedures in the home, community, and school. For example, technology allows automatic computer-based decision making on some care procedures versus decision making by an on-site nurse or physician (e.g., dosage levels for medications that can now be administered through technology devices). Some medical procedures have been so simplified by this technology that they can be handled on an outpatient basis, at home by traveling nurses, or by parents and other caregivers. With adequate training, monitoring of performance, and supervision, nonmedical personnel now can handle a variety of procedures formerly performed only by doctors and nurses (Hochstadt & Yost, 1991; Merkens, 1991). There is, therefore, no medical reason to support the provision of educational services to children with special health care needs in segregated settings.

4. What educational models/procedures most inhibit these outcomes?

Educational models that inhibit the desired outcomes are segregated placement options, a centralized system for the delivery of health-related services, and the use of the school nurse or health care professional as direct service staff.

Segregated Placement Options

Traditionally, educators were not responsible for working with students having chronic illnesses or complex medical needs, those requiring special health care procedures. Often these youngsters were regarded as too ill or too medically vulnerable, or the risk has been considered too great for them to participate in regular school or even special education programs. Consequently, these students were typically cared for by health care professionals or by their families in hospitals and in home settings. Often school districts developed centers for students with health care needs, centralizing the provision of nursing care within an educational setting. The segregated placement options continue to be maintained on the basis that children with special health care needs are too fragile, or their needs are too great, for them to be met in an inclusive education program. As stated above, however, there is now no medicalreason for this exclusionary practice. A model that allows for teachers to be the providers of the majority of nursing procedures, supervised by health care professionals, would diffuse the need to centralize services.

Centralized System for the Delivery of Health-Related Services

Administrative models that contribute to the centralization of the provision of health care procedures reduce the likelihood that students will be placed in an inclusive setting and will receive their special health care procedures distributed within the context of their educational programs. If, for example, the health department of a school district is administratively separate from the education department, the provision of health care services will also be viewed as separate. As stated above, it is necessary not to compartmentalize the student into the "medical" part and the "education" part; rather, all the needs must be met within the context of an inclusive educational system.

The School Health Professional as Direct Service Staff

The practice of utilizing the school health professional as direct service staff reinforces the need for the centralization of service and administration. It has become increasingly clear, in both urban and rural areas, that there are not sufficient numbers of school nurses to directly meet the needs of children and youth requiring some form of special health care procedure. A model in which the school health professional provides support to the educator in the implementation of the special health care procedures within the context of the educational program allows for both the inclusion of the child in the educational setting and the instruction of the child in participation in the procedure (Ault, Graff, & Rues, 1993). The school health professional, preferably a nurse practitioner, is the person most qualified to arrange for training and provide support to the educational staff. The actual nursing skills can be released from a trained health care provider to educational personnel (Orelove & Sobsey, 1991). The role of the nurse practitioner is to continue to provide support and assistance with the student within the context of the regular education setting.

5. Provide two or three specific recommendations for action by Congress.

Congress can enhance the educational programs of children with special health care needs by recommending in its Committee Report that (1) the planning and implementation of special health care need be done within the context of a family-centered approach, (2) the Nurse Practice Acts of individual states allow for the release of nursing skills to sufficiently trained personnel in the schools, and (3) teachers' unions encourage properly trained and monitored teachers to participate in the provision of special health care needs to children and youth within the educational setting as a part of the overall curriculum.

Provide Family-Centered Care

The model of family-centered care for children with special health care needs has been under development in medical communities across the nation (Shelton, Jeppson, & Johnson, 1992). The implementation of this approach within the context of the educational setting is consistent with the overall assumptions of parent and family involvement under IDEA and recognizes the family's competence in meeting the child's needs. Specifically, the family should be involved in determining the extent of treatment to be received as well as in training those persons involved in providing special health care within the school setting. The extent to which a school district can decide how to participate in the provision of special health care needs is unclear. While the courts have supported the provision of a variety of special health care procedures within the typical educational program (Department of Education, State of Hawaii, v. Dorr, 1983; Martinez v. School Board of Hillsborough County, Florida, 1988) they have allowed districts to refuse to carry out procedures decided upon by a child's family and primary care physician (VanBiema, 1993; Younger, 1992). Congress could assist in diffusing these confrontations by encouraging districts to become a part of the family-centered process for the provision of special health care needs.

Restructure States' Nurse Practice Acts

Often the Nurse Practice Act, guidelines for the performance of nursing activities within a particular state, makes it difficult for nonnursing persons to perform nursing activities. The Nurse Practice Act specifically identifies what a school nurse may and may not do (Lehr & Noonan, 1989), but the actual effectiveness of these acts seems to vary. And in many cases school personnel seemed unaware that they were often in violation of state or district guidelines when implementing special health care procedures (Ault et al., 1988). The Kansas Nurse Practice Act, for example, specifically allows for the provision of nursing procedures by nonlicensed persons in the schools under the direction of a person licensed to practice (Kansas Public Health, Article 11, 65.1124.). The general assumption, as put forth in Irving Independent School District v. Tatro, 1984) is that if a parent can perform the procedure, then a trained person in the school could also perform the procedure. A congressional urging to broaden individual states' Nurse Practice Acts to allow for the provision of nursing procedures by nonnursing personnel under the direct supervision of licensed medical professionals would allow for the provision of special health care needs within the school setting.

Revise Teachers' Union Contracts to Include the Provision of Special Health Care Procedures

Union contracts in many school districts often dictate and limit who will implement special health care procedures (Lehr & Noonan, 1989). Some teacher contracts specifically state that teachers can, or cannot, participate in many activities related to overall health. These include activities as routine as toilet training to more complex procedures such as suctioning and emergency resuscitation procedures. These restrictions, it may be assumed, reflect a fear of the potential responsibility of providing interventions for which teachers are not trained. Congressional urging of unions to allow teachers, who are properly trained and supervised, to include instruction during the provision of special health care procedures will allow for the overall inclusion of children and youth with special needs.

It is important that Congress take a proactive position in recognizing that teachers are capable of implementing special health care procedures, that the acquisition of many of these skills is necessary for the health and safety of all children and youth, and that the provision of some special health care procedures can be an occasion for instruction. Unfortunately, a Joint Task Force for the Management of Children with Special Health Care Needs (1990) has taken a restrictive approach to identifying the person capable of implementing a range of procedures. This task force, composed of persons from the American Federation of Teachers, the Council for Exceptional Children, the National Association of School Nurses, and the National Education Association, developed a matrix identifying who should have the responsibility for implementing which health care procedures (Lehr & Macurdy, 1994). The difficulty with this approach is that they based their designation upon roles rather than skills (Sobsey & Cox, 1991). For example, while teachers were allowed to perform oral feeding, only nurses could perform gastrostomy tube feeding. It is often the case, however, that oral feeding requires a great deal of knowledge and skill in positioning, handling, and facilitating, while tube feeding can be rather rudimentary. Although nurses may appear to be the logical persons to implement procedures, they are often not available nor do they have the skills necessary to implement low-incidence procedures (Ault, Rues, & Graff, 1994; Hester, Goodwin, & Igoe, 1980). The identification of persons responsible for the implementation of special health care procedures must be linked to training and continued monitoring of performance rather than specific persons with specific job descriptions.

6. Provide two or three specific recommendations for improving IDEA 's implementation through federally funded activities, including but not limited to monitoring technical assistance, personnel preparation, demonstration, and research, to be carried out over the next five years.

The improvement of IDEA in the inclusion of children with special health care needs in the regular education settings could be facilitated by training programs, at both the preservice and in-service levels, which provide teachers with the knowledge and skills necessary to meet the needs of children and youth with a variety of special health care needs.

Expand Preservice Personnel Preparation Programs

Funding of preservice personnel preparation programs should require the inclusion of competencies dealing with special health care needs. These may include, for example, knowledge on the prevalence of specific conditions and the role of the educator in meeting the student's special health care needs within the context of the educational program. The personnel training program should also provide for direct training in critical areas such as CPR, infection control, first aid, and medication administration. The preservice student should also have access to training in a number of specialized health care procedures, such as gastrostomy feeding, tracheostomy suctioning, or oxygen supplementation, in order to familiarize the student with the process of using nursing protocols and adaptations specific to individual students.

Encourage the Use of Multimedia in the Dissemination of Information

Many of the procedures requiring specialized training are accessed by teachers only if and when they are presented with a student having a particular need. Access to basic information and skill training, when it is needed, becomes critical. The Federal Government could assist in providing information "when needed" by funding strategies for providing information and training utilizing multimedia. One criticism of the vast amount of information currently available in the area of special health care is that this material provides information, not training (Lehr & Macurdy, 1994). The development of new CD-ROM technology, however, allows for the actual training and monitoring of teacher skills (Bashinski, Ault, & Guy, 1994). It is possible that nursing protocols can be taught utilizing CD-ROM technology. After general protocols are learned, training of specialized procedures for individual students can be completed with the cooperation of the family and students' primary health care provider. Teachers should also be able to access current state-of-the-art information concerning the application of specific health care procedures through Usernet Wide Newsgroups on the Internet dealing with these issues. The government could support teachers' access to information on special health care needs by specifically funding projects or organizations providing information utilizing multimedia strategies, CD-ROM, and the Internet.

7. Provide two or three specific recommendations for improving IDEA's implementation by state and local educational agencies.

States could improve the education and inclusion of children and youth with special health care needs by (1) monitoring their IEPs to include (a) the instruction of aspects of the health care procedures within the context of the educational program, (b) the use of a family-centered model in IEP development, and (c) the implementation of the IEP in an inclusive setting; (2) supporting the use of nurse practitioners as support persons to the overall educational program (rather than direct service providers); and, (3) supporting the in-service training of teachers in the area of special health care procedures.

Much of the impetus for innovative programs comes from the leadership of the state boards of education. The state has the capacity to lead the development of IEPs that reflect a family-centered approach to the provision of special health care procedures. In requiring that the IEP account for the instruction and implementation of special health care procedures within the context of an inclusive educational setting, the state can significantly affect the educational experience of a wide range of students. Requiring the provision of special health care procedures within the regular education context requires a decentralized administrative structure and fosters a cooperative relationship between the districts' health care professionals and the educational staff. Further incentives can address the issues of training, family involvement in a family-centered approach, role release, and the supportive relationship of the nurse practitioner to the classroom and building staff.

References

Ault, M. M., Guess, D., Struth, L., & Thompson, B. (1988). The implementation of health related procedures in classrooms for students with severe multiple impairments. Journal of the Association for Persons with Severe Handicaps, 13(2), 100-109.

Ault, M. M., Graff, G. C., & Rues, J. P. (1993). Special health care procedures and teaching. In M. Snell, (Ed.) Systematic instruction of persons with severe disabilities (4th ed.) (pp. 215-249). Columbus, OH: Merrill.

Ault, M. M., Rues, J. P., & Graff, G. C. (1994). Special health care needs. In L. Sternberg (Ed.), Individuals with profound handicaps: Instructional and assistive strategies (pp. 231-296). Austin: Pro-Ed.

Bashinski, S., Ault, M. M., & Guy, B. (1994). Application of the ABLE Training Model: Inservice training based on CD-ROM technology. Paper presented at 1994 TASH International Convention, Atlanta, GA.

Burbage, E. (1992). Classroom adaptations for children with special health care needs. Paper presented at the Annual Convention for the Council for Exceptional Children, Baltimore, MD.

Department of Education, State of Hawaii, v. Dorr, 727 F.2d 809 (D.H. Cir. 1983).

Graff, C., Ault, M. M., Guess, D., Taylor, M., & Thompson, B. (1990). Health care for students with disabilities: An illustrated medical guide for the classroom. Baltimore, MD: Paul H. Brookes.

Graff, J. C., & Ault, M. M. (1993). Guidelines for working with students having special health care needs. Journal of School Health, 63(8), 335-339.

Haynie, M., Porter, S. M., & Palfrey, J. S. (1989). Children assisted by medical technology in educational settings: Guidelines for care. Boston: Project School Care, The Children's Hospital.

Hester, H. K., Goodwin, L. D., & Igoe, J. B. (1980). The SNAP school nurse survey: Summary of procedures and results. Project #1846002587Al. Washington, DC: U.S. Department of Maternal and Child Health.

Hochstadt, N. J., & Yost, D. M. (1991). The health care-child welfare partnership: The transition of medically complex children to the community. In N. J. Hochstadt & D. M. Yost (Eds.), The medically complex child: The transition to home care (pp. 191-206). New York: Harwood Academic Publishers.

Joint Task Force for the Management of Children with Special Health Care Needs. (1990). Guidelines for the delineation of roles and responsibilities for the safe delivery of specialized health care in the educational setting. Reston, VA: Council for Exceptional Children.

Kansas Public Health, Article 11, 65.1124.

Learner Managed Designs. (1992). Feeding procedures, positioning and handling, infection control, clean intermittent catheterization. Lawrence, KS: Author.

Leff, P. T., & Walizer, E. H. (1992). Building the healing partnership: Parents, professionals, and children with chronic illnesses and disabilities. Cambridge, MA: Brookline Books.

Lehr, D., & Macurdy, S. (1994). Meeting special health care needs of students. In M. Agran, N. E. Marchand-Martella, & R. C. Martella (Eds.), Promoting health and safety skills for independent living. Baltimore: Paul H. Brookes.

Lehr, D., & Noonan, M. J. (1989). Issues in the education of students with complex health care needs. In D. H. Lehr & F. Brown (Eds.), Persons with profound disabilities: Issues and practices, (pp. 139-160). Baltimore: Paul H. Brookes.

Martinez v. School Board of Hillsborough County, Florida, 692 F. Supp. 1293 (MD FL 1988).

Merkens, M. J. (1991). From intensive care unit to home: The role of pediatric transitional care. In N. J. Hochstadt & D. M. Yost (Eds.), The medically complex child: The transition to home care (pp. 61-78). New York: Harwood Academic Publishers.

Meyer Rehabilitation Institute. (1991a). Making that important decision: Parent's perspectives on G-tube feeding. Omaha, NE: University of Nebraska Medical Center.

Meyer Rehabilitation Institute. (1991b). Life after your child's G-tube placement. Omaha, NE: University of Nebraska Medical Center.

Nader, P. R. (Ed.) (1993). School health: Policy and practice. Elk Grove Village, IL: American Academy of Pediatrics.

Nelson, R., Young, L., Maurer, S. A., & Burt, C. J. (1990). A survey of special health care procedures required by students in Iowa schools: A preliminary report. Des Moines, IA: Iowa Department of Education.

Orelove, F., & Sobsey, D. ( 1991). Designing transdisciplinary services. In F. Orelove & D. Sobsey (Eds.), Educating children with multiple disabilities: A transdisciplinary approach, (2nd ed.) (pp. 1-32). Baltimore, MD: Paul H. Brookes.

Peterson, N., Barber, P., & Ault, M. M. (1994). Children with special health care needs in early childhood special education. In B. Spodek & P. Safford (Eds.), Year book in early childhood education. Volume 5 (pp. 165-191). New York: Teachers College Press.

Rainforth, B., York, J., & Macdonald, C. (1992). Collaborative teams for students with severe disabilities. Baltimore, MD: Paul H. Brookes.

Shelton, T. L, Jeppson, E. S., & Johnson, B. H. (1992). Family centered care for children with special health care needs. Bethesda, MD: Association for the Care of Children's Health.

Siegel-Causey, E., Rues, J., Harty, J., Roberts, S., Guess, D., & Ault, M. M. (1991). Analysis of medical and educational characteristics among students with severe, multiple impairments. Unpublished paper. Lawrence, KS: The University of Kansas, Department of Special Education.

Smith, P. D., & Leatherby, J. L. (1992). Services for students with special health care needs: Guidelines for local school districts. In P. Lewis & H.L Kleinert (Eds.), Kentucky systems change project for students with severe disabilities. Lexington, KY: University Affiliated Program, The University of Kentucky.

Sobsey, D., & Cox, A. W. (1991). Integrating health care and educational programs. In F. P. Orelove & D. Sobsey (Eds.), Educating children with multiple disabilities: A transdisciplinary approach (2nd ed.) (pp. 155-186). Baltimore, MD: Paul H. Brookes.

VanBiema, B. (1993, Oct. 11). An education in death. Time, p. 60.

Younger, S. J. (1992). A physician/ethicist response: A student's rights are not so simple. Kennedy Institute of Ethics Journal, 2, (1), 13-19.

Annotated Literature Abstract

Citation

Ault, M. M., Graff, G. C., & Rues, J. P. (1993). Special health care procedures and teaching. In M. Snell (Ed.), Systematic instruction of persons with severe disabilities (4th ed.). Columbus, OH: Merrill.

Abstract

The authors propose that teachers consider the provision of special health care needs as a part of the educational process. The presence of a health care need provides additional opportunities for instruction to teach the student to be as independent as possible in the implementation of the procedure (or to participate as possible). Sixteen special health care procedures are reviewed, ranging from CPR and infection control to gastrostomy tube feedings and tracheostomy suctioning. The reader is presented with general information about why this procedure is needed, basics of implementation, and descriptions of emergency situations. Resources for each procedures are also listed.

Key Points and Quotes

1. The need to integrate the provision of special health care procedures into the role of the educator.

"The process of establishing quality health care in the educational setting means a commitment to 1) incorporating the special health care needs of the student into the ongoing educational programming, and 2) actively preventing the development of related health problems or conditions. This commitment must be on the part of the instructional staff as well as the administrative personnel. The teacher, additional teaching staff, and related service personnel must be willing to attend to special health care procedures throughout the educational day as a component of the instructional process. The building principal, director of special education, and other administrative staff must be willing to support this commitment through the provision of necessary training, location of the classroom or instructional setting within the school building, and the availability of additional back-up support personnel." (p. 216)

2. A discussion of who should implement special health care procedures.

"This chapter contains descriptions of procedures and conditions which may be present with students who require special health care procedures. Within all the discussions no attempt has been made to identify who should be responsible for performing any of the procedures. We have emphasized that regardless of who is responsible, the teacher must be prepared, through training, to meet any emergency situation which may arise. The fact is that states, local districts, and even individual buildings are in the process of identifying if and how special health care needs will be met for individual students. Some of the major factors to address in the decision-making process are the current federal law mandating the provision of educational services, the nurse practice acts for individual states." (p. 229)

3. A discussion of teachers' expectations of the school nurse.

"...a school nurse should function as a member of a group of professionals who bring their expertise together to meet the needs of students. A teacher should not assume, however, that the school nurse will have the knowledge or skill to address all of the special health care procedures that are seen in the schools...but given the background and training, the school nurse is the most qualified member of the team to take a major role in identifying resources, training, and monitoring special health care procedures for individual students." (p. 244)

Annotated Literature Abstract

Citation

Shelton, T. L., Jeppson, E. S., & Johnson, B. H. (1992). Family centered care for children with special health care needs. Bethesda, MD: Association for the Care of Children's Health.

Abstract

Elements of a family-centered care model for children with special health care needs are clearly presented. Although the model presented assumes a medical community, its applicability within the educational setting is readily apparent. The eight elements of the model are presented in an easy-to-read format, with many examples and quotes from families and professionals on how the process worked. The authors present each element in a format that first defines the implication of the component and then provide suggestions on the implementation. Additional sections of the manual include research, a suggested list of implementation checklists and a discussion of their use, and a list of resources.

Key Points and Quotes

1. The definition of a family-centered care model for children with special health care needs.

"Because the ultimate responsibility for managing a child's health, developmental, social, and emotional needs lies with the family, health care systems must enable families to function as primary decision makers, caregivers, teachers, and advocates for their children....As one mother of a child with special needs emphasized, 'I'm not just a member of the team, I'm the captain of the team.'" (p. 4)

2. A delineation of the major difference between parents and professionals (read: any professional).

"Perhaps the greatest barrier to the exchange of information between parents and professionals is what Robin Thomas (1986) has termed as a difference in 'paradigms.' In her interviews with families she became aware of a very real difference in the way health care providers (read: all professionals) see the world....The sharing of information between parents and professionals and among professionals is akin to sharing a fragile and precious commodity. The sharing must be carefully nurtured." (p. 15)

3. The need for flexibility.

"If anything can be anticipated in the life of a child with a chronic illness or disabling condition, it is that the child and his or her family will have a variety of needs that will require a myriad of services; that they will interact with hundreds of professionals; and that their needs will change over time. In order to serve these children appropriately, the health care system must be flexible, accessible, and responsive to family needs." (p. 45)

Model Profile

Jason was lucky. From his earliest preschool experiences Jason was able to learn, share experiences, and develop friendships with his peers. From birth, Jason participated in the Circle of Inclusion Project, an early childhood inclusion project jointly sponsored by The University of Kansas Department of Special Education and the Lawrence, Kansas, Public School, USD 497. After extensive infant intervention, Jason was enrolled in a Montessori preschool in his foster mom's neighborhood at age three. In spite of his inability to move independently, talk, or hold his head up for extended periods of time, Jason made many friends among his classmates because of his winning smile, engaging eyes, and his obvious enjoyment in sharing materials and activities with his classmates. Jason continued through preschool and kindergarten in this warm and accepting environment and thrived. Still unable to move independently, he held his head up for extended periods. His classmates learned to understand his requests and answers by following his eye gaze, interpreting his physical response, or waiting for his yes-no response. Jason was born with hydrocephalus and continued to receive medications to control seizures throughout his attendance at school.

At six years old, Jason was enrolled in first grade in New York Elementary School, his neighborhood school. This was the first time the regular education teacher had shared her classroom with a child having significant disabilities. With additional personnel to support inclusion from the school district and related service staff, the first year passed. Difficulties were addressed, and Jason continued to attend school with his peers through second grade.

During the summer Jason's shunt began to malfunction, and after a series of evaluations it became clear that it was impossible to correct the problem. Jason's head began to grow as the ventricles collected and retained cerebral spinal fluid. It became increasingly difficult for Jason to hold up or move his head to indicate yes-no. Though still very engaging, it was harder for him to interact for extended periods of time and he became tired more often.

After receiving information about Jason's condition, the principal and staff at New York School were very concerned about his ability to continue in the third grade. Their concern was for Jason's health and well-being, as well as for the needs of his classmates. It was clear that Jason's condition was terminal, and everyone was very apprehensive about enrolling a child in school who was going to die. Many questions arose, such as: How were they to deal with him, his family, his friends? Was it fair to bring a child into the school who would also bring such pain for everyone around him? Was it fair to the other children? Was it fair to Jason? The staff was also concerned about how to respond to his increasing medical needs, how to recognize when he was in pain, how to anticipate what would happen. Of particular concern was how to respond to his death. What should happen if he were to die at school? But once it became clear that it would be to Jason's benefit to continue to have him as a part of the class, as much as he could tolerate, efforts were made to provide the staff and students with the necessary information to deal with his changing condition and to prepare them for his death.

Jason began third grade, and the staff began to prepare for Jason's anticipated decline and death. The faculty and administration sought assistance from The University of Kansas Medical Center's Child Development Unit to identify what to expect and how to respond. Jason's family was also involved in determining his daily routines and decisions about his level of attendance. School district counselors participated with the staff and students on dealing with a failing child in the classroom. Jason did not finish the school year. He died at home with the support of a hospice program, and his friends planted a young tree in the playground during the spring in his memory.

For more information, contact:

Barbara Thompson, Ph.D.
Department of Special Education
The University of Kansas
3001 Dole
Lawrence, Kansas 66045

Carolyn Graff, M.N., R.N.
Child Development Unit
The University of Kansas Medical Center
3901 Rainbow
Kansas City, Kansas 66160

VISUAL IMPAIRMENTS

Sandra Lewis
Florida State University

Abstract

1. Individuals with visual impairments can manage their own lives as adults when their educational programs focus on the development of the academic competencies typically taught in schools and focus on, with equal emphasis, the development of the functional, disability-specific competencies required by persons with visual impairments in our society.
   
   
2. Outcomes related to school success appear to have been achieved for most students with visual impairments. Outcomes related to independent functioning outside of school environments have not been satisfactorily achieved for all students with visual impairments.
   
   
3. When the procedures for identification, assessment, determination of short- and long-range goals, placement, and service provision are carefully followed, as defined in IDEA, visually impaired students achieve independent outcomes more frequently. Positive student outcomes occur when (a) students receive comprehensive assessments, (b) a continuum of least restrictive placement options are available and considered for each student, and (c) individuals working with the students understand their unique learning style and disability-specific educational needs.
   
   
4. (a) Inadequate educational assessment, improper program planning, limited least restrictive placement options, and educational interventions that are not intense enough or that are determined by individuals unfamiliar with the learning style of students with visual impairments inhibit critical outcomes of these students. (b) "Full" inclusion, local control, and generic service delivery particularly negatively affect student outcomes.
   
   
5. Congress can promote the improvement of outcomes by (a) improving implementation of IDEA, (b) funding regional assessment and technical assistance centers, (c) increasing funding for personnel training, (d) authorizing demonstration projects that develop and further define models of best practice, and (e) requiring publishers of educational materials to provide those materials in accessible formats, such as braille or computer disk.
   
   
6. OSERS can promote the improvement of outcomes by (a) reducing the emphasis on "full" inclusion when monitoring states for compliance and when establishing priorities for research and demonstration projects and (b) advocating for the establishment of a National Commission on the Education of Students with Visual Impairments.
   
   
7. State and local agencies can promote the improvement of outcomes by (a) employing at least one full-time state consultant in the area of visual impairment, (b) financially supporting in-service training for individuals providing services to blind and low-vision students, and (c) conducting comprehensive reviews of the quality of programs serving students with visual impairments.

1. What outcomes within the categorical area are recognized as important for students to obtain?

The population of students with visual impairments is extremely heterogeneous. This heterogeneity applies to many areas, including visual functioning, socioeconomic status, cultural background, age of onset of visual impairment, the presence of concomitant disabilities, and innate cognitive abilities. Some of these students are gifted or have special talents. A large number also have severe and multiple disabilities. Yet each student possesses an important common characteristic: the limited ability to learn incidentally from the environment. These students need direct, specialized instruction to achieve successful post-school outcomes.

For each student who is identified as blind or having low vision, the ultimate school outcomes relate to employment, independent living, economic and social self-sufficiency, and full participation in society. Unless special circumstances exist, individuals with visual impairments typically manage their own lives.

Effective management of a visually impaired person's life involves knowing (1) how to travel safely and efficiently in one's community, (2) how to access needed printed material in a timely way, (3) how to administer readers, drivers, and other paid assistants, (4) how to achieve an assertive and knowledgeable role when working with eye care and other medical professionals, (5) how to perform daily activities using adaptive techniques and equipment, (6) how to advocate for one's rights and responsibilities as a citizen, (7) how to establish and maintain significant relationships with one's friends, children, spouse, neighbors, and co-workers, and (8) how to acquire, maintain, and advance in a meaningful, appropriately challenging job.

For achievement of these disability-specific outcomes, knowledgeable, well-prepared specialists must carefully direct appropriate interventions.

2. To what extent have these outcomes been achieved in the last five years?

SRI's (Wagner, 1993) longitudinal study of special education outcomes revealed that the majority of students with visual impairments (57 percent) who had been out of school for 3-5 years had attended postsecondary school and almost half (46.4 percent) were living independently. These figures seem to support the conclusion that blind and low-vision students are achieving the school outcomes deemed important for successful adult life. More disturbing findings from the SRI study, however, dispute this conclusion. Individuals with visual impairments were among the adults most socially isolated and least likely to be employed (61.5 percent had never been employed).

Thoughtful educators of blind and low-vision students are concerned that, while these students receive the academic supports necessary to master the established core curriculum, their unique educational needs are not adequately addressed. Consequently, mastery of disability-specific outcomes is limited. Too many of these students leave school unprepared to function independently in vocational and community environments. During the last five years, educators of pupils with visual impairments have focused on the negative impact on their students of three prevailing trends within special education: generic service provision, local control, and "full inclusion." These trends surfaced just when these educators were realizing that the past 30 years' experiences of integrating students with visual impairments in general education classrooms had not produced desired outcomes often enough. Achievement of disability-specific outcomes requires frequent, direct instruction by educators knowledgeable of the unique learning styles of these students, often using materials specifically designed for them. Responding to trends that limit direct involvement by specialists has interfered with the development of effective models of best practice for this population.

3. What educational models/procedures are most effective for achieving these outcomes?

The most effective model for achieving the outcomes necessary for full participation in society by blind and low-vision adults is defined in IDEA. Appropriate and desirable outcomes are achieved (1) when students with visual impairments are identified immediately, (2) when students undergo regular, comprehensive assessments conducted by individuals knowledgeable of the impact of visual impairment on learning and development, (3) when IEP team members work together to prioritize short- and long-term educational goals (based on needs identified by the comprehensive assessment), (4) when a continuum of placement options is available, (5) when placement decisions are made by knowledgeable parents and educational personnel who make informed decisions that consider the needs of the students and the educational setting that best meets those needs, and (6) when interventions are coordinated and/or provided by individuals knowledgeable of the impact of visual impairment on learning and who have enough time available to meet students' identified needs. Each of these six components, provided in the order described, is essential for appropriate programming for students with visual impairments.

Because of the heterogeneity of the population of students with visual impairments, the needs of individual students are diverse. Needs are determined only through a comprehensive assessment, which involves a thorough evaluation of a student's visual functioning, concept acquisition, academic achievement, use of communication devices, sensory motor skills, orientation and mobility skills, social/emotional skills, daily living skills, and career/vocational development. For most students with visual impairment, minimal assessment team members include the parent, low-vision specialist, school psychologist, orientation and mobility specialist, speech and language pathologist, and a teacher prepared in the area of visual impairment. Consultation with other specialists occurs when the student manifests concomitant disabilities. For reliable findings, all assessment personnel must be familiar with the impact of visual impairment on learning and work collaboratively to determine students' current level of functioning and needs.

Since the needs of blind and low-vision students are diverse, the educational environments designed to meet student needs vary. IDEA appropriately defines the continuum of placement options. Educators of students with visual impairments support the notion that for each student at any particular point in time, a placement that best meets that student's needs exists. These educators believe that other placements may better suit that child's needs at another point in time. They view all placement options as being of equal value and consider all placements that facilitate optimum learning, regardless of their proximity to the general education classroom or neighborhood school, as being "least restrictive." Each setting has the potential to "restrict learning" for a particular child at a specific time.

Scientists estimate that vision accounts for up to 90 percent of what a seeing child learns about the world in academic, social, and functional skill areas. Since visual input is absent or unreliable, most students with visual impairments require direct, intensive instruction in natural environments to achieve desired outcomes. The individuals coordinating programs and providing educational interventions to blind and low-vision students must understand the educational needs of these youngsters and their unique learning styles, which are unlike the learning styles of any other student population. To be effective, instructors work individually with students to develop the competencies of the disability-specific curriculum and facilitate access to the general core curriculum. This kind of instruction requires small case loads.

4. What educational models/procedures most inhibit these outcomes?

Theoretically, blind and low-vision students are limited in the acquisition of critical outcomes of independent functioning only by the presence of intellectual impairments. In reality, inadequate educational assessment, program planning, placement, and interventions frequently inhibit development of students' full potential. Because visually impaired students often participate competitively in general education classes, uninformed educators, administrators, and parents assume that all of the students' educational needs are being met. Many of these pupils, however, exit school unprepared to function effectively in home, vocational, and community settings.

The model necessary for achieving the desired outcomes for students with visual impairments breaks down at several key points in its typical application. Newly identified or existing students seldom receive comprehensive assessments conducted by individuals knowledgeable of the impact of visual impairment on learning and development. In fact, comprehensive assessments that involve evaluation of each of the areas of potential unique need rarely occur. Assessors generally evaluate only visual functioning, intellectual potential, and academic achievement. IEP teams then place students in whatever general or special educational placement most closely matches the child's apparent intellectual level. Based on this placement, the specialist teacher of the visually impaired determines the level of support that the student requires, and, depending on the number of students carried on the teacher's case load, attempts to provide that support.

This sequence differs considerably from the ideal model established in IDEA. The variation results, in part, from convenience and lack of money, but also from the historical role of teachers of visually impaired children.

When parents and educators developed inclusive educational programs for blind and low-vision students in the 1950s, these pupils' special education teachers focused on facilitating access to the general education curriculum. Teachers almost exclusively directed their activities toward academic support of students. While some direct instruction was provided in disability-specific areas, such as braille reading, most specialist teachers viewed their primary role as support of students' general education teachers. It was not until the mid-1970s, when the first generation of students who had been educated in these settings exited school, that educators realized that inclusion of these students had not been sufficient to produce independent, productive citizens. An overemphasis on academics and disregard for the disability-specific curriculum had led to poor student outcomes.

In the nearly two decades since, thoughtful educators of students with visual impairments have redefined their role to include both academic support of students and direct instruction in disability-specific areas. Mastery of the disability-specific curricula, however, often requires that students receive some of their educational services in specialized environments. It also reduces the amount of time available for teachers to academically support students--frequently the role that creates the most immediate, difficult-to-postpone demands on teachers. As a result, a large number of specialist teachers have not embraced their two-pronged role, have not educated parents and administrators of students' disability-specific needs, and have accepted expanded case loads that preclude the provision of direct services beyond the interventions needed to facilitate students' success in general education.

Innovative teachers attempting to provide disability-specific interventions are inhibited further by the current emphasis on "full inclusion," local control, and the resultant elimination of available special placements in many school districts. Without support from knowledgeable administrators and committed colleagues, these innovators have experienced limited success.

5. Provide two or three specific recommendations for action by Congress.

Congress should promote the improvement of outcomes of students with visual impairments in five different ways.

Improving IDEA's Implementation

Visually impaired students benefit when attention is focused on the mandates of Parts B and H of IDEA. IDEA provides a valuable framework for comprehensive assessment, identification of student needs, determination of placement, and provision of services that lead to desired long-term outcomes. IDEA's inappropriate implementation results in inadequate services that cannot produce effective outcomes in academic and functional areas.

Of particular importance is the need to maintain a full continuum of placement options for students with visual impairments. Because these pupils have difficulty learning through observation, modeling, and imitation, they often require placement in specialized environments for part or all of the school day. In these specialized environments, students master disability-specific skills that can be immediately applied in more inclusive settings.

Funding Regional Resource Centers

Visual impairment is a low-prevalence disability. Few local education agencies have the funds to employ individuals with expertise in assessing and planning effective interventions with blind and low-vision pupils. As a result, local education agencies cannot appropriately educate parents and other staff members about the needs of visually impaired students and cannot conduct valid comprehensive assessments. Regional resource centers should be funded through amendment of Subchapter III to conduct comprehensive assessments, provide technical assistance on program planning, and promote the education of parents, administrators, and other educational specialists of the unique needs of this population of learners.

Authorizing Additional Grants for Training Personnel

Shortages of trained personnel continue to exist in the area of visual impairment. Congress should authorize additional priorities for funding of both undergraduate and graduate level training programs in the education of visually impaired students and orientation and mobility through amendment of Subchapter IV. In addition, Congress should require that funded programs offer courses that specifically teach prospective educators how to assess and meet students' disability-specific needs in the areas of daily living skills, career development, and social-emotional skills. Such a requirement may require that a greater percentage of the grant award be spent on faculty to teach these courses and a correspondingly reduced amount be devoted to student support.

Authorizing Research and Demonstration Programs

Very little is definitively known about the characteristics shared by individuals with visual impairment who achieve successful post-school outcomes. What elements of their past, including early developmental patterns, educational interventions, and available emotional support, contributed to their success? How can these elements be more effectively provided to all children with visual impairments and their families? Congress should amend Subchapter V to authorize and fund research and demonstration projects to explore these and other questions that would more clearly define the model interventions that are associated with successful post-school outcomes.

Requiring Textbook Publishers To Provide Accessible Material

Blind and low-vision students experience considerable difficulty when attempting to access textbooks, educational media, and other learning materials. Subchapter VII should be amended to require publishers of educational materials to meaningfully adapt media for students with visual impairments and to make possible the easy acquisition of printed material in accessible formats, such as braille, large print, or computer disk. Local and national efforts to encourage publishers to voluntarily comply with such requests have experienced limited success. Action by Congress may be the only feasible solution to this significant problem.

6. Provide two or three specific recommendations for improving IDEA's implementation through federally funded activities, including but not limited to monitoring, technical assistance, personnel preparation, demonstration, and research, to be carried out over the next five years.

In an effort to improve the outcomes of students with visual impairments, OSERS can revise its federal monitoring guidelines and priorities for "full inclusion" based research for all disability groups and appropriate funds for the establishment of a National Commission on the Education of Students with Visual Impairments.

Revising Federal Monitoring Guidelines and Research Priorities

Federal monitoring of states involves, in part, a determination of the extent to which local education agencies are providing educational services "in the least restrictive environment." Evaluators determine compliance with this mandate by considering the numbers of students with disabilities served in various placements. States are found out of compliance when it is judged that too few students are served in general education settings.

This method of measuring compliance with the least restrictive environment mandate disregards the critical role of assessment of educational need when making placement decisions, as prescribed by IDEA. Moreover, the monitoring message that state educational agencies and local education agencies hear is that any student who is placed in a general education classroom is appropriately served and that the placement need not be further justified. This message corresponds with the themes supported by OSERS' research and demonstration grant priorities that focus only on projects that involve inclusive educational settings, regardless of disability served.

It should be recalled that educators of visually impaired students pioneered inclusion of students in general education classes. Since the 1960s, the majority of blind and low-vision students have received most of their educational services in general education classes, either at their neighborhood school (the itinerant model) or at a magnet school (the resource room model). Specialist teachers removed students from their neighborhood or magnet school classes as necessary for specialized instruction. With evidence of the failure of many students who received services under these models to become fully included in society as adults, educators determined that some students may require more intensive, direct services than had been provided.

Unfortunately, the emphasis on full inclusion and the federal monitoring procedures with regards to the least restrictive environment mandate have negatively impacted the availability of a full continuum of placement options for students with visual impairments. Nervous local education agency administrators and state educational agency policy-makers anxious to "ride the latest wave" have closed resource rooms and reduced or eliminated itinerant services in favor of a consultative approach. While some students benefit from purely consultative services, other visually impaired learners suffer as their disability-specific needs go unmet.

OSERS should devise more appropriate methods for determining compliance with IDEA's mandate to appropriately serve students based on their needs, as identified through comprehensive assessment. Similarly, OSERS should announce funding priorities for research and demonstration projects that seek to identify best practices that focus on inclusive outcomes, as opposed to inclusive instructional settings; these priorities would generate more interest among researchers interested in students with visual impairment.

Establishing a National Commission on Education of Visually Impaired Students

Several years ago, Congress appropriated funds to support the establishment of the National Commission on the Education of the Deaf. This Commission held nationwide hearings in an effort to determine the status of services to deaf and hearing- impaired pupils and to set priorities for improving those services. The Commission's widely respected and acclaimed report influenced the direction of education of deaf children throughout the country. It focused service providers' attention on the post-school outcomes of deaf students and facilitated effective communication among individuals who held disparate views about the appropriate approach for teaching these youngsters.

Because of the lack among professionals of a unified acceptance of the role of teachers of visually impaired students, and consequently, a lack of direction regarding improvement of the outcomes of students served by these professionals, Congress should include language in its report directing OSERS to fund the establishment of a National Commission on the Education of Students with Visual Impairments. Anticipated outcomes of this Commission would include a statement related to the educational needs of visually impaired learners and the unique competencies of the teachers who serve them.

7. Provide two or three specific recommendations for improving IDEA's implementation by state and local education agencies.

State and local education agencies can improve IDEA's implementation by (a) employing at least one full-time state consultant in the area of visual impairment, (b) financially supporting in-service training for, or conference attendance by, teachers of visually impaired students and orientation and mobility specialists, and (c) conducting comprehensive reviews of programs serving visually impaired students, using published standards.

Employing Categorical Consultants

To assure the free appropriate public education of all visually impaired students, each state should employ at least one full-time state education consultant whose primary duties include advocating for quality program standards, providing leadership to teachers, conducting in-service and parent training, advising personnel preparation programs, and representing the interests of this low-prevalence population at the state and national policymaking level. Without such disability-specific leadership, local education agencies cannot keep informed of the current professional trends influencing quality outcomes of students with visual impairments.

Supporting In-service Opportunities for Specialist Teachers

Also related to the low prevalence of students with disabilities is the limited number of professionals who serve these individuals. Except in very populated areas, teachers of visually impaired students and orientation and mobility specialists work for local education agencies where they are the only such specialist employed. These specialists report feeling isolated from their profession. They often lack the opportunity to confer with colleagues in their chosen field about students' complex problems, effective instructional techniques, and the stress related to providing services to students with wide-ranging abilities and needs. For many of these teachers, in-service programs offered by the local education agencies to meet teachers' needs for updating and improving skills are irrelevant to their case load.

These specialists benefit from attending state and regional conferences attended by their colleagues, where state-of-the-art technology is displayed, where innovative practices and research are introduced, and where peers discuss the common issues facing them in their work. State and local education agencies could financially support specialists' attendance at conferences or appropriate in-service meetings by reserving a portion of the funds provided through the Comprehensive System of Personnel Development (CSPD) for this purpose.

Securing Comprehensive Reviews of Programs Serving Visually Impaired Students

National guidelines for programs serving visually impaired students exist (Hazekamp & Huebner, 1989). These guidelines incorporate 17 standards that describe criteria of quality programs that can be utilized for monitoring purposes. Standards relate to the effectiveness of programs in identifying and assessing unique educational needs, planning and providing instruction and services, and organizing and supporting instruction and services.

State education agencies should facilitate the development of quality programs for students with visual impairments by requiring that local education agencies conduct regular self-reviews of their program. These self-reviews could be followed by an on-site validation review by an independent team of observers. Reviews would not focus on compliance with timelines or legal mandates but rather with the implementation of quality services and the resulting student outcomes. Individuals involved in the program could establish long- and short-range plans for improving program quality based on the findings of the self- and validation reviews. Conducting such reviews on a regular basis would assure that local education agencies responded immediately to the changing needs of the population being served.

References

California State Department of Education. (1987). Program guidelines for visually impaired individuals. Sacramento, CA: Author.

Curry, S. A., & Hatlen, P. H. (1989). Low incidence disability programs quality study: An evaluation of the effectiveness of California SELPAs at achieving published standards for programs and services for students who are deaf-blind, hearing impaired, severely orthopedically impaired, and visually impaired. Sacramento, CA: California State Department of Education, Special Education Division.

Hatlen, P. H., & Curry, S. A. (1987). In support of specialized programs for blind and visually impaired children: The impact of vision loss on learning. Journal of Visual Impairment and Blindness, 81, 7-13.

Hazekamp, J., & Huebner, K. M. (Eds.). (1989). Program planning and evaluation for blind and visually impaired students: National guidelines for educational excellence. New York: American Foundation for the Blind.

Wagner, M. (1993). Trends in postschool outcomes of youth with disabilities: Findings from the National Longitudinal Transition Study of Special Education Students. Menlo Park, CA: SRI International.

Annotated Literature Abstract

Citation

Hazekamp, J., & Huebner, K. M. (Eds.). (1989). Program planning and evaluation for blind and visually impaired students: National guidelines for educational excellence. New York: American Foundation for the Blind.

Abstract

Guidelines include standards and detailed criteria for programs serving visually impaired students. The program planning framework describes and provides a rationale for the multiplicity of specialized skills that blind and low-vision students need to learn and that are unique to them because of their sensory loss or limitation. It also explains and justifies the multiplicity of specialized skills needed by teachers who work with these students. Appendices include resources for technical assistance and funding, position papers on the role and function of the teacher of the visually impaired, the role and responsibility of the state education consultant for the visually impaired, a statement of the ethical requirements related to serving blind and low-vision pupils, and legal requirements.

Key Points and Quotes

1. The least restrictive environment for each student with a visual impairment varies according to the assessed needs of the student.

"The least restrictive environment as defined in P.L. 94-142 may vary for each student with the intensity of the student's needs....Students with needs that require intensive specialized instruction and services should be placed where these can be provided. Placing a student in an integrated setting where he or she does not have the skills or the necessary services to achieve and adapt in this setting can actually be more restrictive to the student. However, visually impaired students who have the necessary skills and services should be placed with nondisabled students to the maximum extent appropriate. But placement in an integrated setting does not mean the student is automatically integrated into the environment....In making the important placement decision, the IEP team should be creative...." (p. 32)

2. Instruction and services provided to students with visual impairments must be planned and coordinated to meet their needs; local control of these programs may be inadequate.

"The concept of regionalization is particularly important for programs serving visually impaired students because these students constitute a low-incidence or low-prevalence group that is small in size and spans a wide range of ages. New programs for visually impaired students should be planned and existing programs modified so that instruction and services necessary to meet these students' varied and unique educational needs, including the provision of essential materials and equipment, can be delivered through coordinated administrative services on a regional basis." (p. 31)

Annotated Literature Abstract

Citation

Hatlen, P. H., & Curry, S. A. (1987). In support of specialized programs for blind and visually impaired children: The impact of vision loss on learning. Journal of Visual Impairment and Blindness, 81, 7-13.

Abstract

The authors divide the learning needs of blind and low-vision children into three categories: needs that are met by adapting the curriculum, needs that are met by changes in methodology, and developmental and educational needs that are unique to these learners. To fulfill the needs in each category, it is essential that instruction be provided by special teachers of the visually impaired who are knowledgeable of the effects of the loss of vision on learning, trained in effective methods of adaptation and remediation, and sensitized to the emotional needs of this population.

Key Points and Quotes

1. Children with visual impairment experience the world and learn in different ways than do their sighted peers.

"If these children are to develop competence and confidence and learn the same material as their sighted peers, it must be recognized that they learn differently, and their experiential deprivations must be compensated for. They cannot observe how the world around them is organized, cannot visually model others' actions, cannot get visual feedback on their actions, and cannot visually generalize from one situation to another. Thus, they need to have materials and the methods by which they are taught adapted and to learn skills specific to their functioning. Because they will not automatically acquire the skills of living, traveling, working, communicating, and socializing from casual experiences and their observations of others, they must be taught these skills in carefully planned, developmentally sequenced programs directed by people who are knowledgeable about the effects of the loss of vision on learning and development." (pp. 12-13)

2. The long-term outcomes of students must not be forgotten in the development of appropriate interventions.

"The challenge for teachers in our field is to not lose sight of the ultimate goal of the education of blind and visually impaired children: the facilitation of healthy growth toward adulthood. If some students are not succeeding in integrated programs, the benefits of their placement should be reevaluated and more effective alternatives should be developed. Furthermore, the different learning styles and unique educational needs of these children should be addressed in our educational programs." (p. 13)

Model Profile

In October 1989, Curry and Hatlen reported on their evaluation of the quality and effectiveness of programs provided to students with low-incidence disabilities in California public schools. They identified the combination of administrators, program specialists, and service providers who understand the potential unique educational needs of these students as being the most powerful determinant of program quality. They recommended that the State of California explore regionalization of services to overcome the barriers presented by limited financial and personnel resources in order to achieve better student outcomes (Curry and Hatlen, 1989).

Acting on this recommendation, the California legislature appropriated funds for pilot regionalization projects in 1991. Special Education Local Plan Areas (SELPAs) designed regional models based on their local needs and submitted applications for funding. The state educational agency awarded one of the $40,000 grants to the proposal submitted by the seven SELPAs in Santa Clara County for their SCORE Project (Santa Clara Valley Opens Regionalized Education). Previously, these SELPAs had worked parallel to and independently of one another. At the onset of the project, the total special education enrollment in Santa Clara County schools approached 25,000 students. Twenty-one specialist teachers served 166 blind and low-vision students in the seven SELPAs.

In planning for the proposal, each of the SELPAs conducted a thorough self-review based upon the Program Guidelines for Visually Impaired Students (California State Department of Education, 1987). Teachers, parents, program specialists, and administrators from each SELPA met to share self-review results and develop a comprehensive plan to meet the following identified needs: (a) to provide a full range of program options for all students; (b) to increase expertise of assessment team members in the disability-specific needs of visually impaired students; (c) to develop a parent training program; (d) to provide for staff development; and (e) to develop disability-specific curricula in needed areas.

With three years of level funding, the SCORE project permanently transformed services to visually impaired students in Santa Clara County. A countywide survey of all schools, agencies, and families identified the residence of every known student, from birth to 21 years of age. Current resource room locations and all student residences were pinpointed on a map and, in consultation with the seven SELPAs' transportation directors, the location of potential resource rooms was identified. The committee recommended that a new resource room be established in the north-central area of the county and the relocation of the southernmost resource room. Currently, all students with visual impairments in the county can readily be transported to, and receive services from, a resource room. Itinerant services and residential placement at the California School for the Blind also are available and considered, when appropriate, for every student.

To improve assessment skills, the SCORE team contracted with the California School for the Blind Statewide Assessment Team to provide an all-day workshop for 22 staff members, among whom were school psychologists, speech and language pathologists, teachers of visually impaired students, orientation and mobility specialists, and adapted physical education specialists. Two members from each of these categories returned for a week to receive more intensive training in the assessment of visually impaired students. SCORE paid a stipend to these volunteers, whose local districts agreed to provide release time when necessary to conduct interdisciplinary assessments of students with uncertain needs within the region.

After surveying parents regarding their training needs, the SCORE team conducted four parent workshops during the second year and three workshops during the third year of the project's implementation. Parents also participated in the in-service training workshop offered to teachers in the region and were welcomed at the regional meetings of the teachers.

The SCORE project provided funding for implementing a strong staff development program. Staff indicated that the best use of these monies would be to support travel and registration costs for attendance at statewide conferences related to the education of students with visual impairments. Regular meetings of teachers and parents facilitated communication and resulted in plans for piloting partnership teaching among interested individuals. Because of the lack of appropriate instructional materials, SCORE contracted with Dr. Sharon Sacks, from San Jose State University, to assist team members with the development of curricula in the areas of social skills and personal management for independent living. The grant paid for the participation of team members as they pooled their expertise to develop documents that have been requested by teachers nationwide.

Regionalization of services to students with visual impairments in Santa Clara County resulted in the significant improvement of those services. Enthusiastic cooperation and open communication among team members succeeded in the establishment of the full range of program options for all students, assessment teams trained to identify the disability-specific needs of visually impaired learners, improved partnerships with parents, empowered and trained staff, and the development of new curricula. The region accomplished what each local SELPA could not: achievement of the high standards of quality and effectiveness that are believed to lead to improved student outcomes.

For more information, contact:

B. J. McCallum, Project Director
1296 Mariposa Avenue
San Jose, California 95126
Phone: 408-971-1353
FAX: 408-998-8838

HEARING IMPAIRMENTS

John Luckner
University of Northern Colorado

Abstract

1. Students who are deaf or hard of hearing should achieve the same educational outcomes and civil rights protection as individuals who do not have a hearing loss. Those include post-secondary education, vocational training, independent living skills, and economic and social self-sufficiency without discrimination. Achieving skills in two languages (e.g., American Sign Language and English) and the ability to interact with two cultures (e.g., deaf and hearing) are essential so individuals who are deaf or hard of hearing can move freely within and between two different communities.
   
   
2. Though there have been improvements in the educational outcomes for students who are deaf or hard of hearing over the past five years, they have not reached a satisfactory level.
   
   
3. (a) All students who are deaf or hard of hearing have unique needs that are directly or indirectly related to communication and language development. (b) In addition, the quality of a student's education is only as good as the available personnel. (c) Finally, effective programs for students who are deaf or hard of hearing provide a wide range of services and educational opportunities.
   
   
4. The predetermination of services or a specific placement, whether based on ideology or the preferred use of existing resources, inhibits students from achieving the desired outcomes.
   
   
5. Congress should (a) fund research that focuses on reducing the average age at which children with hearing loss are identified to no more than six months of age; (b) fund projects that identify ways to increase the abilities of family members to communicate with their children who are deaf or hard of hearing; and (c) change funding formulas from those that provide funds for the number of students who are deaf or hard of hearing who are served to reimbursement for the number of individuals (e.g., students, family members, general education teachers, administrators, speech and language therapists) served.
   
   
6. OSERS should provide money to (a) recruit and prepare professionals from diverse ethnic and linguistic backgrounds, (b) recruit and prepare professionals generally, and (c) conduct research and training on how deaf education professionals can better collaborate as members of multidisciplinary teams and consultants.
   
   
7. State and local education agencies should (a) increase the provision of appropriate services, (b) facilitate collaborations, and (c) develop communication policies and skill evaluations for teachers and staff.

1. What outcomes are recognized as important for students who are deaf or hard of hearing to obtain?

In general, education for students who are deaf or hard of hearing should strive to achieve the same educational outcomes and civil rights protection that are provided for individuals who do not have a hearing loss. Those include post-school activities such as post-secondary education, vocational training, independent living skills, as well as economic and social self-sufficiency without discrimination. Specifically, students who are deaf or hard of hearing should achieve the following outcomes upon completing their secondary education program (Frey, Jakwerth, Lynch, & Purcell, 1993):

Basic Academics

• Complete local minimum general education graduation requirements.

Communication and English Language Competence

• Express themselves effectively in nonwritten communicative interactions.
  
  
• Construct meaning from the nonwritten language used by others.
  
  
• Express themselves effectively when communicating through written language.
  
  
• Construct meaning from the written language used by others.

Personal Productivity

• Proceed toward fulfillment of career, independent living, and other life pursuits.
  
  
• Use community resources and services effectively.

Social and Personal Effectiveness

• Work effectively to build relationships.
  
  
• Proceed effectively in social situations and settings.
  
  
• Manage personal challenges and decisions with responsibility and persistence.

In addition, the development of skills that enable individuals who are deaf or hard of hearing to become bilingual/bicultural members of society are essential (e.g., Christensen & Delgado, 1993; Luetke-Stahlman & Luckner, 1991; Padden & Humphries, 1988). Achieving skills in two languages (e.g., American Sign Language and English) and the ability to interact with two cultures (e.g., deaf and hearing) permit individuals who are deaf or hard of hearing to move freely within and between two different communities.

2. To what extent have these outcomes been achieved in the last five years?

In contrast to youth in general education settings and other students with disabilities, students who are deaf or hard of hearing are significantly more successful at completing high school (Wagner, 1991). It was reported in the 1991-92 Annual Survey of Students Who Are Deaf or Hard of Hearing (Schildroth & Hotto, 1993) that 65 percent of the students graduated with a diploma, 23 percent received a certificate, and 12 percent dropped out. However, Holt (1993) reported a lag in the reading achievement of students who are deaf and hard of hearing, with a median grade equivalent of 4.5 for reading comprehension at the time students leave high school. Despite this low level of achievement, students with hearing loss as a group appear to have achieved at higher levels over the last decade when it was reported that students who are deaf or hard of hearing had a median grade level range of 2.9 to 3.2 for reading comprehension (Allen, 1986).

During the academic year 1992-1993, an estimated 20,040 students who are deaf or hard of hearing were enrolled in two-year and four-year post-secondary education institutions. This is an increase of approximately 3,000 students since academic year 1989-90 (U.S. Department of Education, 1994). While this is a promising statistic, research suggests that between 40 percent and 50 percent drop out of college prior to receiving a degree. Those who do complete a post-secondary program are most often awarded degrees at the two-year level (Schroedel & Watson, 1991).

Research on what happens to individuals who are deaf or hard of hearing after they leave their educational program is mixed. Bullis, Bull, Johnson, Johnson, and Kittrell (1990) reported the results of a comprehensive school-to-community transition study conducted in the northwest portion of the United States. They noted that individuals who are deaf or hard of hearing are less likely to be involved in productive activities, such as work or school, are more depressed, and have fewer friends than their hearing peers. However, members of the National Longitudinal Transition Study of Special Education Students reported that youth who are deaf or hard of hearing were engaged in productive educational or work activity outside the home between one and two years after leaving secondary school at comparatively high rates (83 percent and 86.7 percent, respectively) as compared with other disability groups (Jay, 1991) and that parents indicated that social isolation existed for only 14.3 percent of deaf students and 15.6 percent of hard of hearing students (Newman, 1991).

With regard to work, a national follow-up study reported by Macleod-Gallinger (1992) found that one year after graduation 53 percent of the respondents were unemployed. However, by 10 years after graduation the picture improved considerably, with almost 81 percent of the respondents who were deaf or hard of hearing reporting that they were employed. While a positive increase in employment from year one to year 10 after high school graduation existed, a significant difference between the 7 percent unemployment rate of the hearing population and the 19 percent reported by Macleod-Gallinger (1992) persists.

Workers who are deaf or hard of hearing are employed more often in blue collar jobs than their hearing peers. They receive fewer promotions and as a result, 10 years after high school graduation, they have an occupational profile that is similar to hearing workers in their early years of employment (Macleod-Gallinger, 1992). These reflect the continued problems with underemployment for workers who are deaf or hard of hearing (Vernon & Andrews, 1990). Similarly, workers who are deaf or hard of hearing earn significantly less than their same-age hearing cohorts. This trend is true for those individuals who are out of high school one year as well as those who graduated 10 years earlier (Macleod-Gallinger, 1992).

3. What educational models/ procedures are most effective for achieving these outcomes?

Unfortunately, there is no single answer to the question because of the growing diversity of students attending schools today and the heterogeneity of the population of students who are deaf or hard of hearing. Yet, all students who are deaf or hard of hearing have unique needs that multidisciplinary team members should carefully consider when determining appropriate educational services and placement for a student. An effective educational program for students who are deaf or hard of hearing considers the following factors (NASDSE, 1994):

1. the student's communication and language abilities;
   
   
2. the student's academic and developmental level and needs;
   
   
3. the preference of the student and the family;
   
   
4. the degree of the student's hearing loss and his or her ability to make use of residual hearing;
   
   
5. quality of interpreting services and the student's ability to use them;
   
   
6. the potential for the student's appropriate social and emotional development;
   
   
7. the availability of a sufficient number of age-appropriate peers who are deaf or hard of hearing;
   
   
8. the opportunity for bilingual and bicultural development;
   
   
9. opportunities for direct (i.e., without the use of an interpreter or other support personnel) communication with teachers;
   
   
10. the qualifications and communication competencies of personnel;
    
    
11. access to pupil personnel services staffed by individuals knowledgeable of the needs of students who are deaf or hard of hearing;
    
    
12. the availability and accessibility to extracurricular activities; and
    
    
13. the availability of needed technology.

Each of these areas represents a critical factor in the determination of the provision of appropriate services and placement. Concomitantly, the quality of a student's education is only as good as the personnel who perform assessments, develop the individualized educational plan (IEP), provide services, and supervise the program. The need for qualified teachers of deaf and hard of hearing students, supervisors, and support services (i.e., school counselor, teacher's aide, audiologist, interpreter, speech therapist) who have training and experience in the area of deafness is directly related to student outcomes.

Finally, effective programs for students who are deaf or hard of hearing provide a wide range of services and educational opportunities. Those programs that cannot provide an array of services and options because of low enrollment (e.g., schools in rural settings) regionalize their services with other districts in order to meet the individual needs of students.

4. What educational models/procedures most inhibit these outcomes?

Hearing loss results in significant and unique educational needs for students. Establishing appropriate educational programs for these students is a complex task, requiring the sorting out of the multiple factors previously noted. The predetermination of services or a specific placement, whether based on ideology or the preferred use of existing resources, is inappropriate and potentially harmful to the student.

Deafness and hearing loss present an enigma to educators, both general and special, because of the complexity of the problems associated with developing language and communication skills. As a result, significant differences of opinion exist over what constitutes best practices and best policies for providing appropriate educational services for students who are deaf or hard of hearing. This debate is compounded by the facts that compelling evidence, based on generalizable research, is not readily available and all too often policies and decisions are made based on emotional, rather than empirical, grounds.

Schildroth (1988) reported that (a) 4,412 schools had only one deaf student enrolled in the entire school; (b) 1,372 schools had only two deaf students enrolled in the entire school; and (c) 628 schools had only three deaf students enrolled in the entire school. Because deafness is a low-incidence disability, there is no widespread understanding of its educational implications. Given the complexity of providing appropriate services for students who are deaf or hard of hearing and the need for qualified personnel to provide and/or consult about those services, it is questionable whether each of the students in the schools noted above receives the appropriate services that enable him or her to achieve the desired outcomes.

For students who are deaf and hard of hearing to be educated effectively, educational personnel must be able to integrate the students into the social milieu and the learning activities of the school and classroom. This includes establishing environments that promote the student's development of rewarding friendships and feelings of social support, and the student's participation in learning activities on an equal basis with peers, uninhibited by communication and attitudinal barriers. For this to happen, educational programs need to make a firm commitment to hiring qualified personnel and providing appropriate services. When they are unwilling to hire certified personnel or unable to provide those services, students must have the option to receive an appropriate education in a different setting, such as a center-based program or a residential school. Congress should take action in three ways.

5. Provide two or three specific recommendations for action by Congress.

Reducing the Average Age at Which Children with Hearing Loss are Identified to No More Than Six Months of Age

Congress should promote early identification of hearing loss by funding demonstration projects to expand and to document systematically the cost efficiency and efficacy of current techniques such as High-risk Registries (HRR) for hearing loss, auditory brainstem response (ABR), and transient evoked otocoustic emissions (TEOAE). The average age of identification for children who are deaf or hard of hearing in the United States is reported as two and one half years (Commission on Education of the Deaf, 1988). Currently, of the approximately four million live births each year, 95 to 97 percent are not tested for hearing loss (Bess & Hall, 1992). Only 14 states have legislated mandates for newborn hearing screening (Blake & Hall, 1990). Early identification is critical because hearing loss interferes with the development of communication skills, which in turn impact individuals' ability to interact and learn in traditional ways.

Concomitantly, there is significant need to educate pediatricians about identification and the developmental needs of infants and toddlers who are deaf or hard of hearing. Most pediatricians have not had any course work or training experience related to hearing loss. As a result, they have a limited understanding of the importance of referring an infant or toddler for a hearing screening, the cultural aspects of deafness, and how to work with families when their child has been identified with a hearing loss. If pediatricians do not understand the child's need for hearing testing, their attitudes may allay parental concerns, creating a false sense of security regarding the child's hearing status. In accordance with the objectives for Healthy People 2000, professionals, along with parents, must continue to focus on lowering the age of identification and intervention of hearing loss.

Increase the Abilities of Family Members to Communicate with Their Children Who Are Deaf or Hard of Hearing

Congress should authorize and fund programs that increase the ability of family members to communicate with their children who are deaf or hard of hearing.

The family is the most important part of a child's support system. Families also have the most influence in their children's development and language acquisition. Current theory of human development acknowledges the reciprocity of parent-child interactions and their qualitative effects on all areas of child development. The ability to communicate effectively is necessary for cognitive development, social and emotional development, linguistic competence, and academic growth. Children form concepts, develop vocabularies, learn values, and achieve educational goals through communication. Children who are deaf or hard of hearing who are not exposed to early language input are likely to experience severe deficits that will impact on future development and learning.

Most children who are deaf or hard of hearing (90 percent) have parents/caregivers who are hearing. Most families' first real experiences with hearing loss occur with the birth of their child who is deaf or hard of hearing. As a result, many children who are deaf or hard of hearing are unable to communicate clearly and unambiguously with other members of their family (Meyers & Bartee, 1992).

Families need to be assisted in developing communication skills from the time the child is identified throughout the child's education years. With most families having both parents working outside the home and the growing number of single parents, there is increasingly less time for family members to attend formal classes that help them learn how to communicate with their deaf child. Consequently, funding for the development of alternative approaches to training such as "Sign With Me: A Family Sign Program" (Moeller, Schick, & Williams, 1994), which is a video series that provides information about communication principles, parenting principles, and communication strategies that facilitate language acquisition, is essential. Similarly, funding for comprehensive home intervention programs such as SKI*HI (Clark & Watkins, 1985) and the Colorado Home Intervention Program (CHIP) (Stredler-Brown & Yohinaga-Itano, 1994) need to be expanded and implemented in all parts of the country. Finally, funds need to be allocated and research needs to be undertaken on how to successfully provide communication training to all family members, including fathers, brothers, sisters, and the extended family.

Changing Funding Formulas from Those That Provide Funds for the Number of Students Who Are Deaf or Hard of Hearing Who Are Served to Those That Reimburse for the Number of Individuals (e.g., Students, Family Members, General Education Teachers, Administrators, Speech and Language Therapists) Served

Since the mid 1970s the number of students who are deaf or hard of hearing in general education programs has increased steadily. Craig and Craig (1986) reported that approximately 29 percent of deaf students in the United States attend state-run residential schools for the deaf, and 68 percent attend public schools either in special classes for deaf and hard of hearing students or in general education classes with an interpreter or supplementary services from a teacher of students who are deaf or hard of hearing. More recent data (U.S. Department of Education, 1994) suggest that on a national level approximately 77 percent of students who are deaf or hard of hearing are served at least on a part-time basis in general education classroom settings.

An obstacle with regard to providing appropriate services in general education settings centers around the fact that many of these students require educational modifications and adaptations in order to achieve academic skills commensurate with their innate abilities (Paul & Quigley, 1990). However, most general education teachers and school personnel have had no previous exposure to individuals with a hearing loss or experience in teaching these students (Commission on Education of the Deaf, 1988). Consequently, research (Chorost, 1988; Martin, Bernstein, Daly, & Cody, 1988) indicates that general education teachers believe that they are not adequately prepared to educate these students in general education settings and that they prefer to teach students only if substantial support personnel and in-service training are available. Accordingly, greater emphasis, as well as research and funding, needs to be focused on adult-to-adult interactions, whereby professionals in deaf education consult, collaborate, and when appropriate, teach other adults how to work with children and youth who are deaf or hard of hearing.

In addition, there is growing awareness of the importance of providing early intervention (including family-focused intervention) to children who are deaf or hard of hearing, using Individualized Family Service Plan (IFSP) as the linchpin for service provision. Given the importance of family-professional collaboration as the key to planning and implementing intervention, then all professionals, family members, and individuals from community agencies must be able to engage in ongoing conversations about resources, training, concerns, and priorities. To work with families and personnel in other agencies, professionals need to be trained, required, and remunerated for providing these essential services. When educational agencies focus solely on the number of children who receive direct services, a significant portion of the child's environment does not receive the support and training that it needs to enhance the child's development and successful attainment of the desired educational outcomes.

6. Provide two or three specific recommendations for improving IDEA's implementation through federally funded activities, including but not limited to monitoring, technical assistance, personnel preparation, demonstration, and research, to be carried out over the next five years.

OSERS can take action on three fronts.

Providing Money to Conduct Research and to Recruit and Prepare Professionals in Education of Students Who Are Deaf or Hard of Hearing Who Are from Diverse Ethnic and Linguistic Backgrounds

It is estimated that by the year 2000, one-third of school-aged children in the general population will be from ethnically diverse backgrounds (American Council on Education, 1988). Similar sociological changes are having a significant impact on the field of deaf education. Students who are deaf or hard of hearing from linguistically diverse homes are the fastest growing part of the deaf population (Schildroth & Hotto, 1993). Similarly, there is a shortage of deaf and hard of hearing teachers of students who are deaf or hard of hearing.

Consequently, federally funded projects that examine how to recruit and prepare individuals who are from diverse ethnic, cultural, and linguistic backgrounds are essential. In addition, states should develop alternative strategies for teacher certification or licensure (such as performance evaluations) so that individuals who are deaf or from other linguistically diverse cultures are not prohibited from teaching because of discriminatory testing that is required to become certified or licensed.

Providing Money to Conduct Research and to Recruit and Prepare Professionals in Deaf Education Who Are Knowledgeable of Providing Appropriate Services for Students Who Are Deaf or Hard of Hearing Who Have Disabilities in Addition to a Hearing Loss and for Students Who Are Hard of Hearing or Who Have a Unilateral Hearing Loss.

There has been a significant increase in the number of students who are deaf or hard of hearing who have disabilities (Kelly, Forney, Parker-Fisher, & Jones, 1993). Schildroth and Hotto (1993) reported that 30 to 33 percent of the students who are deaf or hard of hearing have additional disabilities. Additional disabilities have a negative effect on communication, language, and academic achievement of students. The difficulty of establishing effective educational programs for students who are deaf or hard of hearing with additional disabilities is such that the effects of another disability are not simply additive, but rather they interact with each other in ways not thoroughly understood to create a complex array of secondary consequences. Therefore, federally funded projects that examine how assess, plan, provide services as well as prepare personnel are necessary.

Also, there has been a significant increase in the number of students who have less-than-severe hearing losses (hearing thresholds of 70dB or lower) (Schildroth & Hotto, 1993). Approximately 16 per 1,000 school-aged students have an average hearing loss between 26 and 70 dB in the better ear. This is eight times the number of students who are deaf (NASDSE, 1994). The majority of these students exhibit significant academic deficits. For example, Davis, Elfenbein, Schum, and Bentler (1986) found that these students demonstrated developmental delays in the areas of verbal skills, academic achievement, and social skills in comparison with a control group of hearing peers. Similarly, students with unilateral hearing loss have significant problems in the areas of auditory and psycholinguistic skills, educational progress, communication, and classroom behavior. Bess and Tharpe (1986) reported that 35 percent of students with unilateral hearing losses had repeated a grade, in contrast to a normal failure rate of about 3.5 percent. Finally, although conductive hearing loss is most often of a fluctuating nature, recent evidence indicates that the periodic hearing loss associated with otitis media may have long-term effects on the language and intellectual development of children.

Providing Funds to Conduct Research and Training That Focus on How Deaf Education Professionals Can Better Collaborate and Function as Members of Multidisciplinary Teams and as Consultants to General Education Professionals, Families, and Community Members

Despite the dramatic increase in the emphasis of school consultation in the professional literature in recent years, "most educators, administrators, and community members have had little training or experience functioning in collaborative consultation roles" (Thousand, Villa, Paolucci-Whitcomb, & Nevin, 1992, p. 228). As a result, Philips and McCullough (1990) assert that the "collaboration ethic remains inoperative in most school settings" (p. 291). This is evident in the field of education of students who are deaf or hard of hearing. In a study conducted by Luckner (1991) involving 354 general education teachers who worked with students who were deaf or hard of hearing in the general education classroom, respondents indicated that they received "minimal assistance" from the teacher of deaf and hard of hearing students and that they most often interacted with the teacher of deaf and hard of hearing students in "informal brief discussions."

Educating students who are deaf or hard of hearing demands a knowledge of effective educational practices as well as a knowledge of the consequences of a hearing loss on the social, emotional, academic, and psychological abilities of these individuals. While general agreement on the necessity of collaboration and consultation exists within professionals in the field (e.g., American Speech-Language-Hearing Association, 1991; Council for Exceptional Children, 1992), this area of training has not been addressed by most state certification agencies in the area of deaf education.

Similar concerns and the need for research and training surround the use of multidisciplinary teams. IDEA required educational programs to make significant changes in how they provide educational and related services to students who are deaf or hard of hearing. One aspect of the legislation mandated that decisions for the delivery of special services to students who are deaf or hard of hearing were not to be the sole responsibility of a single individual. Consequently, multidisciplinary teams were established to (a) increase accuracy in assessment; (b) improve classification and placement decisions; (c) provide a forum for sharing different views; (d) provide specialized consultative services to school personnel, parents, and community agencies; and (e) provide the resources for developing and evaluating individualized educational programs (Reynolds, Gutkin, Elliott, & Witt, 1984).

To date, there has been no research examining the teams' effectiveness for meeting these goals for students who are deaf or hard of hearing. Rather, concerns that often surface regarding the teams' functioning can be divided into the following four areas: (a) the teams' unsystematic approach to collecting and reviewing data, (b) the minimal involvement of parents and general education teachers, (c) the loosely structured decision-making processes that teams use; and (d) the lack of interdisciplinary collaboration and trust. While professionals and parents are required by law to participate in discussions about the placement and services that are best for students who are deaf or hard of hearing, there are limited data to suggest that these individuals function as a team or make decisions in the best interest of students who are deaf or hard of hearing.

7. Provide two or three specific recommendations for improving IDEA's implementation by state and local education agencies.

State and local educational agencies should take action on at least three fronts.

Increasing the Provision of Appropriate Services to Children Who Are Deaf or Hard of Hearing

The continuum of special education services (Deno, 1970) is actually a continuum of placements. Within each placement, there is no assurance about the quality or quantity of services that are provided for students. Often students are placed in an educational setting without proper monitoring of their progress. Because of the heterogeneity of the population in communicative, academic, auditory, and social/emotional skills, or cultural perspective, it is not possible to prescribe specific services based on age or degree of hearing loss. Whether a service is appropriate for a particular student can only be determined by a thorough evaluation of the student's skills in and out of the classroom.

While compliance monitoring was a necessary force for securing procedural safeguards when IDEA was first implemented, there is growing need to increase the current focus on improving the quality and results of the educational experience for students who are deaf or hard of hearing. There should be a renewed emphasis on program evaluation as a necessary tool for determining the effectiveness of programs and services and making informed decisions concerning program improvement (Gonzales, 1992). Education agencies should review programming and placement decisions to determine whether students are making adequate progress. There should exist a process to monitor a student's progress throughout the school year in order to make necessary adjustments and changes as soon as the need is detected. Many students who are deaf or hard of hearing may need more than annual testing and three-year updates to monitor their progress or classroom performance.

The state's certification and licensure standards should be revised to require multicultural competence in educators of the deaf and hard of hearing.

Similar concerns about the quality of educational interpreters and the services that they provide need to be addressed. Interpreting is a process of communicating spoken English into sign, such as American Sign Language (ASL), or into various sign systems, such as Signed English, as well as rendering sign into spoken English. Students who are deaf or hard of hearing who use sign for communication require the services of an educational interpreter to function in the general education classroom and often in all aspects of the school environment. Although interpreting is a rapidly growing profession, there is a significant shortage of skilled and qualified interpreters who can provide the needed services for students.

There are several significant consequences that accompany the existent shortage of skilled professional interpreters. First, because most educational programs have little or no experience with educational interpreters, they have a tendency to confuse signing with interpreting skills. As a result, many school districts hire a person with minimal signing skills to interpret for students who are deaf or hard of hearing. Second, many hired interpreters and school districts are not knowledgeable about communication modality issues (e.g., ASL, Signed English, Signing Exact English, Oral English). As a result, interpreters use their preferred mode of interpreting without being aware of the needs of the student. Third, many educational interpreters have minimal training in areas such as tutoring, administering tests, and solving discipline problems. These are tasks that general education teachers often request educational interpreters to undertake. Fourth, many students who are deaf or hard of hearing do not have the language base needed to use an interpreter. However, many educational programs make the assumption that once an educational interpreter is assigned to a student, all problems associated with providing services for the student are resolved (Hurwitz, 1994). Again, monitoring student progress and evaluating the quality of services that are provided for students are essential.

Developing Job Descriptions and Providing Time for Teachers of Students Who Are Deaf or Hard of Hearing to Work with Other Professionals and Families

In order to design and implement programs for students who are deaf or hard of hearing, school personnel are expected to work together, discuss students and instructional issues, experiment with various solutions, and develop professional relationships. Yet, they are not given the noninstructional time to meet these expectations. The current structure of most education programs does not provide sufficient time for general education and teachers of students who are deaf or hard of hearing to work with their students as well as to communicate and plan with other professionals and parents.

Time and support for ongoing planning and assessment are necessary to make adjustments in the programs of students who are deaf and hard or hearing if they are going to be participating members of the school and classroom. The time constraints of general education teachers and teachers of students who are deaf or hard of hearing as well as scheduling difficulties are serious problems. If professionals are going to collaborate, a schedule and job description that includes sufficient time to work with others must be provided.

In addition, many teachers need to work with family members so that each person in the immediate and extended family can learn to communicate effectively with the child who is deaf or hard of hearing. Professional staff will need flexible schedules that allow them to make home visits and work with families during the hours that family members can be available.

Develop Communication Policies and Skill Evaluations for Teachers and Staff

Few educational programs have developed communication policies about the type of communication (Oral, Cued Speech, ASL, Signed English, Signing Exact English) that they want used with the students who are deaf or hard of hearing who attend their program. Similarly, very few states evaluate the signing skills of teachers for certification. And most teachers' communication skills are not evaluated prior to hiring and even fewer are evaluated after being hired (Gustason, 1994). The quality of the linguistic input that students who are deaf or hard of hearing receive has a significant impact on their ability to develop communication skills. Developing communication policies, evaluating teachers and staff, and providing incentives for them to improve their communication skills would increase adults' ability to communicate, interact, and provide mature language models for students who are deaf or hard of hearing.

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Annotated Literature Abstract

Citation

National Association of State Directors of Special Education (1994). Deaf and hard of hearing students: Educational guidelines. Alexandria, VA: National Association of State Directors of Special Education, Inc.

Abstract

This publication is the summary of the "Deaf Education Initiative Project," which was a collaborative effort undertaken by representatives of 10 national organizations interested in education of students. The document provides guidelines for programs serving students who are deaf or hard of hearing. It describes in detail needed program elements and features which should be considered when designing appropriate services. The document is divided into five chapters, a glossary, and eight appendices. Chapter One provides the foundation for educating students who are deaf or hard of hearing. Chapter Two focuses on support structures and administration. Chapter Three discusses issues surrounding assessment. Chapter Four includes information about program and placement issues, and Chapter Five describes characteristics of personnel who work with students who are deaf or hard of hearing.

Key Points and Quotes

1. The unique communication and language needs of students who are deaf or hard of hearing pose a challenge for conducting appropriate assessment and for developing appropriate educational programs.

"Children who are deaf or hard of hearing have unique cultural and linguistic needs that make them different from other groups of children, with or without disabilities. Most hearing children enter school with the ability to process and integrate verbal information. They have a basic command of the language and an extensive vocabulary. School systems establish programs and services and develop curricula based on the assumption that all children enter school with language skills. With these tools, children are ready for the acquisition of information in content areas. Education systems, in general, help students reach the goals of self-realization, development of proper human relationships, attainment of economic sufficiency, and assumption of civic responsibility. The goals of educating children with hearing loss are identical. However, children with hearing loss seldom bring to their educational experience the same extensive language background or the same breadth of language skills as do hearing children." (p. 2)

2. The social and emotional development of students who are deaf or hard of hearing needs to be considered when planning educational programs.

"Children who are deaf or hard of hearing have a right to an education in an environment that enhances their social and emotional development. Their ability to interact with peers, engage in extracurricular activities, participate fully in athletic programs, and engage in developmentally appropriate discussions with teachers and support personnel is crucial to their overall development. Participation in these activities should not require constant dependence on others (e.g., interpreters) to facilitate communication and interaction. Constant dependence upon others will adversely impact on a child's social and emotional development, and every effort should be made to ensure that the placement site provides sufficient opportunities for active and authentic involvement in school functions independent of support personnel." (pp. 52-53)

Annotated Literature Abstract

Citation

U.S. Department of Education. (1992, October 30). Deaf students education services: Policy guidance. Federal Register, 57(211), 49274-49276.

Abstract

This paper is divided into three parts: Background Information, Free Appropriate Education, and Procedural Safeguards. The background information provides specific guidelines to ensure that students who are deaf are provided with a free appropriate public education which takes in consideration their unique communication and related needs. The second section addresses the implications of a free and appropriate education for children who are deaf with implications for IEP development and placement decisions. Factors that need to be considered are (1) communication needs and preferred mode of communication, (2) linguistic needs, (3) severity of hearing loss and potential for use of residual hearing, (4) academic level, and (5) social, emotional, and cultural needs, including opportunities for peer interactions and communication. The third section focuses on the procedural safeguards ensuring that parents are informed of their rights with regard to decision-making processes, such as placement.

Key Points and Quotes

1. The Commission on Education of the Deaf (COED) reports that students who are deaf encounter considerable barriers in accessing a free appropriate public education that meets their unique language and communication needs.

"Compounding the manifest educational considerations, the communication nature of the disability is inherently isolating, with considerable effect on the interaction with peers and teachers that make up the educational process. This interaction, for the purpose of transmitting knowledge and developing the child's self-esteem and identity, is dependent upon direct communication." (p. 49275)

2. The interpretation of the least restrictive environment (LRE) has been misapplied by presuming that the general education setting is the most appropriate placement for all children who are deaf.

"Any setting, including a regular classroom, that prevents a child who is deaf from receiving an appropriate education that meets his or her needs, including communication needs, is not the LRE for that child." (p. 49277)

"Just as placement in the regular educational setting is required when it is appropriate for the unique needs of a child who is deaf, so is removal from the regular educational setting required when the child's needs cannot be met in that setting with the use of supplementary aids and services." (p. 49277)

3. Parents need to be informed decision makers with regard to placement options.

"The obligation to fully inform parents includes informing the parents that the public agency is required to have a full continuum of placement options available to meet the needs of children with disabilities, including instruction in regular classrooms, special classes, special schools, home instruction, and instruction in hospitals and institutions." (p. 49278)

Model Profile

In the current age of emphasis on educational options for all children, it is refreshing to observe a program that appears to be found on the principle of providing communication for all children, deaf, hard of hearing, and hearing, in the context of their natural, everyday environments. The TRIPOD/Burbank Unified School District Partnership is a collaborative effort that creates a model program of comprehensive education through the co-enrollment of deaf, hard of hearing, and hearing children in the public school system. Children are co-enrolled in a general education/special education partnership that has as one of its components the unique aspect of co-teaching. Co-teaching teams a general education teacher with a special education teacher, thus increasing the student-ratio slightly for the special educator and decreasing the ratio for the general educator. Support provided by special education paraprofessionals and by parent volunteers is also factored into the overall student-adult ratio, making the individual child-adult interaction favorable to all students in the program.

In a co-enrollment classroom at TRIPOD, it is frequently difficult to determine which teacher is a special educator and which is a general educator. All of the teachers use sign language, some are fluent ASL signers, and others use a contact variety of Signed English with ASL features, but the important consideration is that all of the children, regardless of their hearing status, are receiving salient communication, in one form or another, all of the time. Child-to-child interactions are as prominent as adult-to-child interactions--everyone is involved in the process of communication and language acquisition in a dynamic teaching/learning environment.

TRIPOD began as a Montessori preschool in 1984 and has grown, year by year, into a program that now serves children and youth who are deaf, hard of hearing, and hearing from infancy through grade nine. The TRIPOD Board of Directors, Professional Advisory Board, and Educational Advisory Board combine the expertise of parents and professionals to oversee the entire program and provide support as needed to sustain quality and innovative education practice. Families are supported by the Family Sign Program, the Parent Association, and Open Forums that provide information on all aspects of child-rearing and educational issues. Beyond the immediate school program, TRIPOD reaches into the community through a toll-free hotline, a newsletter, development of informational videotapes, and public service captioned films.

TRIPOD staff are engaged in research efforts that document the success and progress of the program. Currently 112 students who are deaf or hard of hearing of all ethnic/cultural backgrounds receive services through TRIPOD. Children with multiple disabilities are included also. Hearing students and general education teachers sign for themselves and students and teachers who are deaf or hard of hearing communicate in their mode of preference.

A review of test scores over the past several years shows a marked improvement for the students who are deaf or hard of hearing on such measures as the California Test of Basic Skills (CTBS) and the Stanford Achievement Test (SAT-HI). Levels of achievement in reading and math are gaining steadily. Children are learning in an environment that includes all communication options and encourages the growth and self-esteem in each and every child. A feeling of respect for children, families, and staff permeates the classroom setting and has a positive effect, to some degree, on everyone involved.

In sum, TRIPOD is more than a school program. It is a way of life, a "philosophy in practice," for children, families, professional educators, and support staff. It is a place where students who are deaf, hard of hearing, or hearing teach each other from a natural communication environment.

For more information, contact:

Carl Kirchner, Director
TRIPOD
2901 North Keystone Street
Burbank, California 91504-1620