Related Services in School and Beyond can Support a Child’s Development and Learning

A Brief Overview

  • At school, related services help children with disabilities benefit from their special education by providing extra help and support. Options for related services are described in state law (WAC 392-172A-01155).
  • If a child with public health insurance needs specific therapies to meet medical needs, their insurance company is obligated to support those needs. Medical necessity is described in state law (WAC 182-500-0070).
  • Sometimes a service meets educational and medical needs. In those situations, the school might bill Medicaid directly, with parent permission. Families can learn more about School-Based Health Services (SBHS) and ask if their school is participating in this optional program.
  • Washington’s Office of Superintendent of Public Instruction (OSPI) issued guidance in August 2022 to clarify that all parts of a student’s IEP begin with the start of school unless an IEP team has agreed to shift something to meet a student-centered need. Schools may not delay the start of related services for their own reasons related to scheduling or resources.
  • For federal information about the range of options for related services provided by the school, see parentcenterhub.org.

Full Article

Children with disabilities have a range of needs that may be educational, medical, or both. As they grow, develop, and learn, those needs can shift. How family, school, and medical providers respond can impact how much progress the child makes in their emerging skills. This article includes information to help families understand how therapeutic services may be provided at school or elsewhere.

What are related services?

Schools call services that lie outside the scope of traditional teaching “related services.” Another term is “ancillary services.” Related services help children with disabilities benefit from their special education by providing extra help and support.

Therapies for disabilities that impact physical movement or speech are common. Transportation provided through the special education system also is a common related service. Less common in Washington State are in-school mental health services or counseling for behavioral health conditions. Various possibilities are listed in state law (WAC 392-172A-01155). Here are examples from the Washington Administrative Code (WAC):

  • Occupational, Physical, Speech Therapies
  • Counseling
  • Psychological Services
  • Behavioral Services
  • School Social Worker
  • Special Transportation
  • Parent Training

What does parent training mean?

Notice that the final option on this list is parent training. This service might mean the school helps parents understand the special needs of their child or something about their child’s development. Through the related service of parent training, the school can teach family members to help their child practice emerging skills when they’re at home.

Who provides a related service, and who pays?

A related service may be provided by any professional who is trained to assess and/or serve a specific need for a child with a disability condition that affects their learning or development.

When therapeutic services are paid for through medical insurance, they generally must meet a standard of being “medically necessary.” Keep reading for more information about therapeutic services available through the medical system.

Services are provided at school when they are determined to be “educationally necessary.” In those cases, the school district is responsible for payment.

Sometimes a service is both medically and educationally necessary. Sometimes schools seek parent consent to bill the student’s insurance to fund all or part of a related service. Washington State’s Health Care Authority (HCA) manages a program to reimburse schools for services provided to students who are eligible for Apple Health when those services are delivered as part of their Individualized Education Program (IEP).

Tip: See HCA’s website page about School-Based Health Services (SBHS) and consider asking your school if they are participating in this optional program. The guidebook includes information about allowable services. Note that Applied Behavior Analysis (ABA) therapy is explicitly excluded as a reimbursable service through the state’s SBHS program. Most other therapeutic options are reimbursable, including a range of mental health services.

A related service might be part of evaluation

Sometimes a related service is needed to assess a student because school staff do not have the expertise to properly understand a disability condition in order to make service recommendations. “Medical services for diagnostic or evaluation purposes” are written into federal law (IDEA Section 1432) as something an IEP can provide.

Keep in mind that special education evaluations must be comprehensive, in order to identify all of a child’s special education and related service needs, not just those that relate to the IEP eligibility category.

Families can seek an Independent Educational Evaluation (IEE) if they disagree with the methods or conclusions of a school district special education evaluation. PAVE provides an article and sample letter for requesting an IEE.

Related services support FAPE

The federal law that governs special education services is the Individuals with Disabilities Education Act (IDEA). The IDEA makes clear that its list of related services (see below) includes possibilities and options but does not include every related service a student might need. Other therapeutic services might be included in the IEP if they are educationally necessary.

Access and equity are protected by various educational and civil rights laws; anything that helps a student access school-related opportunities can be included as part of a student’s services. Extracurricular activities and school-sponsored sports count.

An IEP is a written commitment for the school to serve a student’s educational needs. Educational needs might be academic, social-emotional, or something else.  They might have to do with how the student functions or adapts to the environment of school.

Educational needs are determined through a comprehensive evaluation and a collaborative process that includes family, school staff, and anyone else with knowledge of the student and their disability-related needs. If an IEP team decides that a service is necessary for the student to access their right to a Free Appropriate Public Education (FAPE), then the school district is responsible to deliver those services.

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

School-based related services might include, but are not limited to:

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

The national Center for Parent Information and Resources (parentcenterhub.org) provides additional information about each of these possible related services and what they might look like for a student receiving them as part of an Individualized Education Program (IEP).

IEP services start on Day 1 unless the student needs something different

Washington’s Office of Superintendent of Public Instruction (OSPI) issued guidance in August 2022 to clarify that all parts of a student’s IEP begin with the start of school unless an IEP team has agreed to shift something to meet a student-centered need.

According to OSPI, “School districts are reminded that they cannot arbitrarily determine when special education and related services will begin or schedule them to begin after the start of the school year for some providers.”

OSPI’s guidance references a parent complaint and the state’s decision that schools cannot delay the start of certain services because of provider availability or district scheduling preferences. If it’s in the IEP, then the school is responsible to provide the service on all scheduled days that the student attends school. If services aren’t provided as scheduled by the IEP, then the IEP team can discuss how and when the student will receive compensatory services to make up the missed time.

Families have the right to file a complaint with the state if the school does not fully serve their student’s IEP. One option is the community complaint: PAVE provides a video describing that process. Another option is Due Process. The Procedural Safeguards describe all dispute resolution options that are free for families and protected rights under federal and state laws. 

Options for therapeutic services through the Medicaid system

If a child needs specific therapies to meet medical needs, their insurance company is obligated to support those needs. For children younger than 21 with Medicaid (Apple Health in Washington), medical necessity is determined through assessments that are a protected benefit called Early Screening and Periodic Screening, Diagnostic and Treatment (EPSDT). This screening process is overseen by the National Academy for State Health Policy (NASHP).

For help navigating complex medical issues, families can request case management from their insurance provider. Calling the number on your insurance card and asking if there a form for requesting case management is a way to begin. Sometimes a case manager is automatically assigned if claims become complex and expensive.

Medical criteria are different than school criteria. While school-based services are built to support a student’s educational access, EPSDT determinations are made to support safety and health in the home and community. Here are examples:

  • Physical Therapy (PT) at school might support adapted physical education (PE) or help the student navigate the school building or curriculum. Outside of school, PT can support navigating the home, community, recreational activities, and more.
  • Speech/language services at school are tailored to help the student achieve goals on their Individualized Education Program (IEP) or access their curriculum. Outside of school, speech/language services can expand to support communication for daily living and might be paired with Occupational Therapy (OT), for example, to work on feeding issues, sensory aversions, breathing challenges, alternative communication systems, and more.

Services to support access to school, home, and community might intertwine, and the school district might choose to bill Medicaid for reimbursement, with the family’s signed consent.

TIP: If the school is going to bill insurance, families may want to find out if the insurance company has a reimbursement limit for the service. If the child is getting a similar service in and out of school, care coordination is important to make sure all the services will be paid. Insurance may be willing to pay for more services if it’s clear which are for school-based needs and which are medical. Those details also may be important to note if services are denied and the family wants to appeal the denial through a medical or special education complaint option.

What meets the standard of medical necessity?

The Washington Administrative Code (WAC 182-500-0070) describes medical necessity. If a service is likely to prevent, diagnose, or treat an identified condition that is causing major life impacts, then it may meet the standard. The WAC says medical necessity is:

“…a term for describing requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions in the client that endanger life, or cause suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction.”

The same WAC goes on to say that all federally funded insurance is obligated to pay for a service if it’s the most reasonable option available to serve the need. That standard is met when:

“There is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the client requesting the service.”

The same WAC also explains that a chosen course of treatment might mean a choice to track a condition through observation or offer no treatment. The WAC says:

“For the purposes of this section, ‘course of treatment’ may include mere observation or, where appropriate, no medical treatment at all.” 

A medical specialist, therapist, or pediatrician might assess the child to determine whether a specific service is medically necessary. In some situations, a case manager from the state’s Developmental Disabilities Administration (DDA) may make the determination.

What about private insurance?

Families with insurance through an employer or the healthcare exchange will need to ask their provider for specific information about what therapeutic services are covered. A company’s human resources department is another place to ask about coverages and whether there is a choice of health plan with more allowable options. School-based services may be the only option for some, as medical parity laws do not protect all possible therapeutic services.

Here are a places to get support in understanding your health plan and navigating access to services:

Insurance denials for employer-based plans can be appealed through:

PAVE’s Family to Family (F2F) Health Information Center provides additional information and resources through it’s website, Family Voices of Washington. Click Get Help at wapave.org to request individualized support.

Special Education is a Service, Not a Place

A Brief Overview

  • A student with a disability has the right to a Free Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE). General education spaces and curriculum are LRE.
  • Services are generally portable, and special education is delivered to the student to enable access to FAPE within the LRE to the maximum extent appropriate.
  • Federal law protects a student’s right to FAPE within the LRE in light of a child’s circumstances, not for convenience of resource allocation.
  • The TIES Center at the University of Minnesota partnered with the Haring Center for Inclusive Education at the University of Washington to build a resource to support families and schools in writing IEPs that support students within general education classrooms: Comprehensive Inclusive Education: General Education and the Inclusive IEP.

Full Article

An ill-informed conversation about special education might go something like this:

  • Is your child in special education?
  • Yes.
  • Oh, so your student goes to school in that special classroom, by the office…in the portable…at the end of the hall…in a segregated room?

This conversation includes errors in understanding about what special education is, how it is delivered, and a student’s right to be included with general education peers whenever and wherever possible.

This article intends to clear up confusion. An important concept to understand is in the headline:

Special Education is a service, not a place!

Services are portable, so special education is delivered to the student in the placement that works for the student to receive a Free Appropriate Public Education (FAPE), in light of the child’s circumstances. A student with a disability has the right to FAPE in the Least Restrictive Environment (LRE).

General education is the Least Restrictive Environment. An alternative placement is discussed by the student’s Individualized Education Program (IEP) team if access to FAPE is not working for the student in a general education setting with supplementary aids and supports.

Here is some vocabulary to further understanding:

  • FAPE: Free Appropriate Public Education. The entitlement of a student who is eligible for special education services.
  • IDEA: Individuals with Disabilities Education Act. The entitlement to FAPE is protected by this law that allocates federal funds to support eligible students.
  • LRE: Least Restrictive Environment. A student eligible for special education services has a right to FAPE in the LRE to the maximum extent appropriate. General education is the least restrictive, and an alternative placement is discussed when data indicate that supplementary aids and supports are not working to enable access to FAPE in general education.
  • IEP: Individualized Education Program. School staff and family caregivers make up an IEP team. The team is responsible to develop a program reasonably calculated to enable a student to make progress appropriate toward IEP goals and on grade-level curriculum, in light of the child’s circumstances. Based on a student’s strengths and needs (discovered through evaluation, observation, and review of data), the team collaborates to decide what services enable FAPE and how to deliver those services. Where services are delivered is the last part of the IEP process, and decisions are made by all team members, unless family caregivers choose to excuse some participants or waive the right to a full team process.
  • Equity: When access is achieved with supports so that a person with a disability has a more level or fair opportunity to benefit from the building, service, or program. For example, a student in a wheelchair can access a school with stairs if there is also a ramp. A person with a behavioral health condition might need a unique type of “ramp” to access equitable learning opportunities within general education.
  • Inclusion: When people of all abilities experience an opportunity together, and individuals with disabilities have supports they need to be contributing participants and to receive equal benefit. Although IDEA does not explicitly demand inclusion, the requirement for FAPE in the Least Restrictive Environment is how inclusion is built into special education process.
  • Placement: Where a student learns. Because the IDEA requires LRE, an IEP team considers equity and inclusion in discussions about where a student receives education. General education placement is the Least Restrictive Environment. An IEP team considers ways to offer supplementary aids and supports to enable access to LRE. If interventions fail to enable access to FAPE, the IEP team considers a continuum of placement alternatives—special education classrooms, alternative schools, home-bound instruction, day treatment, residential placement, or an alternative that is uniquely designed. 
  • Supplementary Aids and Supports: The help and productivity enhancers a student needs. Under the IDEA, a student’s unique program and services are intended to enable access to FAPE within LRE. Note that an aid or a support—a service that enables access—is not a place and therefore cannot be considered as an aspect of a restrictive placement. Having a 1:1 to support a student, for example, does not violate LRE. This topic was included in the resolution of a 2017 Citizen Complaint in Washington State. 

Note that the IDEA protects a student’s right to FAPE within LRE in light of a child’s circumstances, not in light of the most convenient way to organize school district resources. Placement is individualized to support a student’s strengths and abilities as well as the needs that are based in disability.

Tip: Families can remind the IEP team to Presume Competence and to boost a student from that position of faith. If the team presumes that a student can be competent in general education, how does it impact the team’s conversation about access to FAPE and placement?

LRE does not mean students with disabilities are on their own

To deliver FAPE, a school district provides lessons uniquely designed to address a student’s strengths and struggles (Specially Designed Instruction/SDI). In addition, the IEP team is responsible to design individualized accommodations and modifications.

  • Accommodations: Productivity enhancers. Examples: adjusted time to complete a task, assistive technology, a different mode for tracking an assignment or schedule, accessible reading materials with text-to-speech or videos embedded with sign language…
  • Modifications: Changes to a requirement. Examples: an alternative test, fewer problems on a worksheet, credit for a video presentation or vision board instead of a term paper.

Note that accommodations and modifications are not “special favors.” Utilizing these is an exercise of disability rights that are protected by the IDEA and civil rights/anti-discrimination laws that include the Rehabilitation Act of 1973 (particularly Section 504 as it relates to school) and the Americans with Disabilities Act (ADA—particularly Title II).

Related Services may support LRE and other aspects of equitable access

An IEP may include related services (occupational therapy, speech, nursing, behavioral health support, parent training, etc.). For some students, related services may be part of the support structure to enable inclusion in the Least Restrictive Environment. If an IEP includes related services, then the IEP team discusses how and where they are delivered.

A tool to support inclusion

The TIES Center at the University of Minnesota partnered with the Haring Center for Inclusive Education at the University of Washington to build a resource to support families and schools in writing IEPs that support students within general education classrooms: Comprehensive Inclusive Education: General Education and the Inclusive IEP.

The resource includes a variety of tools and recommendations for how school and family teams can approach their meetings and conversations to support the creation and provision of a program that recognizes:

  • Each child is a general education student. 
  • The general education curriculum and routines and the Individual Education Program (IEP) comprise a student’s full educational program.
  • the IEP for a student qualifying for special education services is not the student’s curriculum.

Keep in mind that IEP teams are required to include staff from general education and special education (WAC 392-172A-03095). All team members are required for formal meetings unless the family signs consent for those absences. Here’s a key statement from the TIES Center resource:

“The IEP is intended to support a student’s progress in general education curriculum and routines, as well as other essential skills that support a student’s independence or interdependence across school, home, and other community environments.  A comprehensive inclusive education program based upon these principles is important because without that focus, a student’s learning opportunities and school and post-school outcomes are diminished. In order to create an effective comprehensive inclusive education program, collaboration between general educators, special educators, and families is needed.”