Dr. Sarah Pelangka, special education advocate and owner of KnowIEPs, explains related services in an IEP such as speech therapy, 1:1 aides, AAC, and more during this Undivided Learning event. For a recap of the highlights, check out this article.
For more information about IEP related services, go here.
Lindsay Crain
I’m Lindsay Crain and I head the content and community teams at Undivided. With me today we welcome back Dr. Pelangka. Hello, Dr. Pelangka, always great seeing you. I do have to kind of shout out, you're all very lucky, Dr. Pelangka’s kids are all out of school and she’s still here! We give you a gold medal and we're very very appreciative.
Dr. Pelangka
And hopefully they don't come barging in in the middle of it. I feel like every time I do need these, something goes wrong, goes awry, so hoping that a dog doesn't bark and my kids don't barge in.
LC
So Dr. Pelangka, what are related services? And then we're going to get into the specifics of some of them more closely.
Dr. P
In a nutshell, related services are any and all services that support a student's access to special education and specialized academic instruction. And then there's supplementary aids and services, which support a student's access to general education. That’s kind of the difference of the two.
LC
Is there sort of a set list of legally allowed services or can somebody say, “Hey, this should be a related service for my child, like what about this?”
Dr. P
Yeah, I mean, I've had you know, parents request hippotherapy, which is the horse therapy, and all kinds of fun things. So unfortunately, there are limitations. There is a pretty set list. And I'm not sure we're gonna list some of those now and we're gonna go through that later.
LC
You can throw out the list now and then we'll dive into all of those.
Dr. P
Transportation a very common one, right? In order to access your specialized academic instruction, you have to be able to access the location in which they'll be provided, so transportation would be a related service. Speech language therapy, occupational therapy, physical therapy, vision services, orientation and mobility, recreation and leisure. That's one oftentimes parents aren't aware. DHH, the Deaf and Hard of Hearing Services, behavior intervention services. Those are probably the most familiar and most common, I’m sure I'm leaving a few off but we’ll get to them as we talk more today. Assistive technology, individualized intensive education, or 1:1 aide, that’s a big one.
LC
Before we talk about a lot of those bigger and smaller related services, how do parents know if their children actually need related services? Should the school be offering us all of the appropriate available services during our IEPs?
Dr. P
So it really comes down to, I guess, starting with your qualifying initial eligibility meeting in which you find out whether or not your child qualifies for special education, right. Assuming your child does qualify, then every three years, give or take, you're going to have that triennial or that re-evaluation. So every time your child is evaluated, you want to utilize that information to really determine kind of your child's strengths and also your child's areas of need, right? And also eligibility. So one would obviously assume that if a child or a student is qualifying under Speech Language Impairment, they're obviously going to need Speech Language Services. Some related services are a little bit less clear-cut. There isn't necessarily a section in that assessment report that directly speaks to like assistive technology, for example.
So how do parents know? It's really a matter of kind of knowing and understanding your child and what you know can benefit your child like, hey, my child does better typing than handwriting. Right? So can we talk about that? Unfortunately, I think parents are often uninformed or maybe misinformed about whether or not that is something that's available, and that's where it becomes a challenge. You know, parents don't know what they don't know. And so then the question is, you know, should districts be informing parents of this at the time of this assessment? Of course, that should be happening, right. If there's ever an area of suspected need, that should be kind of laid out on the table as an area to consider. Like, we noticed that your child is struggling with gross motor. Oh, adaptive P.E., that’s another related service. Do you think you would be interested in an APE assessment? Is that what's happening? Usually not, and again, if parents don't know that that's an option, that's where things can kind of go amiss, and then you don't know that your child could have had access to that related service. So opportunities such as these where we're kind of sharing that information is really helpful. And you don't have to wait for those evaluations. Anytime throughout the year, if you're feeling like hey, my kids’ struggling in reading and he's just not getting it, you know, an assistive tech assessment might be worthwhile. Put in that request, and then they’ll assess.
LC
So if something isn’t offered by the district, and we ask about it, can the district say no to those requests?
Dr. P
Yes. So legally, what would happen is anytime a parent or a caregiver requests an assessment, the district is going to respond in writing either way, they're either going to grant the assessment, in which case you'll receive the prior written notice in the assessment plan. Right? Or they're going to deny the assessment. And anytime an assessment is denied, they have to provide in writing the reason and rationale by a prior written notice as to why they're denying that assessment. And they have to have a really strong rationale. So the only time I’ve really ever seen that happen, which has been very rare, is really when there's just no logical explanation as to why the student would need that, like they aren't struggling. They're doing well, there's really no data to support a need for that area. And so in those cases, they may deny, but nine times out of ten, it's it's gonna get, you know, granted, because if they're denying that assessment, they can be liable, right, for if that student could have benefited from that. So how do they know if they aren’t assessing? Does that make sense?
LC
It does. Also I want to expand a little bit on educationally appropriate because let’s take PT, for example, which I know we're going to talk about in a second, but you can have all kinds of PT. Private PT covers, you know, certain things but in school it only covers things that are educationally appropriate, or you know, how it relates to school. So how should parents sort of set those expectations?
Dr. P
Yeah, that's a great question. It has to provide meaningful educational benefits. So I would say, physical therapy, occupational therapy, and speech language therapy are probably the most common in which there can be that confusion. A parent wants to say well, my child is receiving service outside of school through their insurance, and they're working on, you know, dressing, or ambulating around the street, or what have you. And so it can be confusing for parents if the child is receiving that service outside, but what schools and districts are required to provide are PT services or OT or speech language that allows them to access their education. So what that would look like for PT specifically is are they able to ambulate around the campus? A that does include the play structure, it's not just getting to and from their classroom or the major points on the campus. It is anywhere they may need to go to safely access the structure in the playground and play amongst their peers, right. Being able to get to and from the cafeteria or the office. So all of that is included, and you know, if there's an uneven pavement, are they able to ambulate and navigate that? So looking at all of those pieces. Also, you know, sitting properly, are they bumping into things in the classroom, are they able to maintain their posture and feet and all of those things, that's what they're looking at. Whereas medically necessary, maybe looking at other things, and so it's not going to directly translate. It's not going to be identical to what they're receiving outside necessarily.
LC
What about a stander? I'm just thinking about that because I know other families have asked for that and sometimes get pushback. If they want their child stretching out and standing, and if their child is able to do that, they want to get out of their wheelchair and be able to stretch or stand even with that support in class. Is that something that's appropriate that families can ask for during the school day?
Dr. P
Absolutely. I have a number of clients who have a stander and it's written into their IEP. And obviously the PT would need a provider to support either consulting and collaborating with adults to ensure it's being used properly, showing how to get in and out, and/or any direct services, fitting the stander, all of that. Really quick, one more thing about the stander, it just reminded me of low-incidence equipment. Another thing for families to be mindful of is oftentimes the conversation will come with eligibility if you have a low incidence eligibility, so like vision, Deaf and Hard of Hearing orthopedic impairment that requires equipment, they'll often argue they should be on the front page.
You know, nine times out of ten, that's probably appropriate. But if it's if the student qualifies for multiple and that isn't deemed one of the primary or secondary, it's not required for them to receive the funding or to be able to fund the equipment. It just means that they wouldn't receive the funding from the source that they would like to receive the funding from. But they would still be able to fund the equipment if they aren't on the front page. So that's just something else to note.
LC
Is there an advantage of having those on the front page of as the qualifying diagnoses versus not?
Dr. P
That’s a whole conversation. I'm of one mindset, other people are of another. I feel like it's important because if it were me, I would want my profile to be as accurate as possible and to describe me as who I am. You know, a lot of school sites like to say it doesn't matter. You've already entered the door to special education, you're here. Why does it matter? I don't agree with that. I mean, the teacher is going to look at it and whether we want to admit it or not, it's going to give an immediate impression, right? And so I think it needs to be accurate. So I'm just saying that, you know, that's always the conversation whenever equipment is involved, they would like to have that funding source. That doesn't mean if that's not on the front page, your child won't receive that equipment, it would still be funded.
LC
So back to the question, because we did have some general questions ahead of time with RSVPs. Can you have an IEP only for related service services?
Dr. P
Yeah, I mean, if your child only qualifies under speech language impairment and they don't need any SAI, then their case manager would be the speech language pathologist, and they would only have goals for speech and language. Now, other related services, no, you wouldn't have an IEP just for like occupational therapy. Or like just for assistive technologies. So again, because really related services are supposed to support the student in accessing special education, a 504 is generally more what we're looking at for like supplementary aids and services only, and you can also just have a 504 that would just have like, speech language therapy on it, right? It's rare, but it can happen. Also in preschool, that's an option as speech language therapy only IEP.
But I would say SLI is probably the only one where there would only be the related services and no SAI. Because yeah, like if you're having an IEP, let's say, for counseling, let's say the student has emotional disturbance. I'm just trying to think of something off the top of my head of my clients. They don't have any academic needs, but they have like social-emotional goals, but then they'll be like SAI consult collab. So they aren't being pulled for like academics, and they don't have academic goals. But the case manager would be the SAI teacher, and they would still be overseeing data and making sure the teacher has any questions or whatnot. So I would say counseling, speech and language. DHH, which is Deaf and hard of hearing. Vision could be another one because I have a client who is legally blind, so she has obviously vision services for, like, Braille reader and all of that. O&M. So they have goals, but she does have an academical, but that could be, if they don't have any academic needs for sure, she would still have access to the IEP.
Low incidence, probably, I’m thinking orthopedic impairments too, because you wouldn't necessarily have academic needs, but you may still have PT. So I think yeah, it just depends on the individual student, right. I mean, based on the eligibility, like I said, that's really what kind of drives some of these related services. Obviously, if you qualify under, you know, Deaf and hard of hearing, you're going to have DHH. If you qualify under vision impairment, you're going to have those services, so it kind of drives some of it.
LC
I wanted to ask about occupational therapy, which is obviously a really big one. So what are some common reasons that students might need OT services?
Dr. P
So OT, as it's related to educational benefit, looks at I mean, the most common obviously is fine motor, right? So handwriting, being able to do your academic work and write on paper, or typing. Typing is huge now too, ever since COVID, but also even pre COVID for middle school up, a lot of academic work has just migrated to electronic and computer based, so typing is huge. Also, OTs can support a lot with assistive tech, so you may not need an AT specialist to necessarily be attached to the IEP, but the OT might be able to support any recommendations after that assessment, and they can support with that, like accessing Grammarly and those types of, you know, extensions for the students to be able to access you know, reading and writing and whatnot. Another area obviously that OT supports is sensory. So sensory regulation, being able to recommend, you know, any sensory diet or accommodations that students might need to be able to best learn in whatever environment they're in, and/or anywhere on the campus, you know at recess and it's overstimulating, and they can support that. Also core strength and core support.
Another one that parents aren't often aware of OTs support is even a level of emotional regulation. So OTs are often attached to goals related to lie zones of regulation. They're actually trained pretty well, pretty well versed in that, and they work on those types of goals to help the student recognize like what zone they're in and what coping strategies to use and things like that. So again, depending on the level of need for that student, but I've seen a lot of OTs attached to those types of goals.
LC
Yeah, I've never heard of an OT being attached to that. But I guess my personal experience is more with behavior side, right, like the needs for that. That’s interesting. So speech and language, obviously another huge one. Like your mentioned early intervention, one of the biggest categories for IEPs especially, but what kinds of communication needs are covered by IEPs.
Dr. P
So for speech and language impairment, like the eligibility, so they look at, obviously language, so receptive language (what the student understands), expressive language (what the student is able to express themselves, whether that's vocally or AAC), they're looking at that and they also look at articulations. So that's an area that they support. They also look at pragmatic language, so how the student communicates with others socially, whether that's non verbal or verbal. And then they also look at voice. So like pitch, volume, and whatnot. Fluency, so like stuttering is an example. That's pretty much it. So you'll see all of those pieces written into the report. And then they also are supposed to do, this just kind of came up in an IEP last week, and I had for the first time ever, but they're also supposed to do like an oral, I don't know the proper term, evaluation of making sure like the muscles and the tongue and everything is working properly. And this particular speech pathologist claimed it was all great. And then the parent was like, well I don't know how that's possible. After she went through her full report, she's like, she can't move her tongue side to side. Come to find out the pathologist is like, well we were wearing masks, so I wasn't able to look at that. And I'm like, well you literally just said and it's written here that everything checked out, so you don't think you should maybe note that in the report, and we should circle back around? And she's like, okay, that would be good. Definitely if you're questioning anything, or you feel like something may not be accurate, please speak up because I would have no way of knowing, you know, I don't know that she can’t move her tongue side to side. So parents, you know your child better than anybody. So if you feel like something is not accurate, definitely speak up.
LC
Where does AAC fit into related services for speech and language?
Dr. P
So AAC, assistive and augmentative communication, is generally thought to be used for students who may be nonvocal, but it can also be obviously a supplemental form of communication. It's not necessarily meant to replace anyone's voice, although if someone genuinely cannot vocalize, it could definitely be their primary means of communicating. So, if a speech and language assessment comes back for a student and it’s a student who has pretty significant expressive delays, because AAC would be a means of expressing right, or maybe they have pretty significant articulation errors that's making their language very unintelligible, particularly to unfamiliar people, that can heavily impact social interaction, right? If you're trying to talk to peers and they don't understand you, that could pose as a barrier. So those are the occasions in which you may want to, as a parent or a caregiver, request an AAC assessment, if that's not suggested by the team or the speech language pathologists, and it may or may not be somebody different. It usually is. There's usually someone who's kind of deemed that AAC specialist, but AAC specialists always have a speech pathology background and speech pathologists may also be AAC specialists, it just depends on the district. So yeah, you can request that assessment and then based on the recommendation, depending on what app is recommended, just make sure that whatever speech pathologist is going to be working with your child, that they are experienced and trained and well versed, and they are capable of training everyone else because it has to be utilized all day every day, right, in order for it to be meaningful.
LC
So I think also important, we were told early on not to work on her articulation goals, but that’s part of her being able to communicate. With social goals as well. Whatever communication system your child is learning, that is part of language, education, communication, everything, so they can really work on communicating with peers. Whether that’s the actual words or communication through AAC or just knowing how to have conversations and really practicing reciprocal conversation.
Dr. P
Yeah, I mean, if the student is expressing themselves vocally and they're able to be understood by the peer, but they're just struggling with pragmatics. I definitely wouldn't recommend AAC. That would just be working on pragmatic language.
LC
I meant for speech in general, for the goals in general, the big range, so people don’t think my child can already vocalize and have conversation whether that’s in AAC or with your voice. So they’re saying we don’t need speech. So there's a lot of mixed messages from districts, so parents should know too if that social piece, if your child is communicating with AAC if they don’t know how to use that functionally with their peers or how to ask for things, that’s still something to keep in mind for a goal.
Dr. P
Absolutely. Something you’ll see a lot is a student will perform well on the pragmatic scale. They can answer the questions correctly, so won’t qualify, so make sure they're also including observations and really looking at student’s language in real time and conversations with others. You can’t just base it off how they respond in a 1:1 setting. I see that a lot, particularly with autism and it’s frustrating. Just be mindful of that.
LC
We just got a question who said the school did not provide assessments but they provided AAC to my son as accommodation because that’s what the private clinic had given my son. However, recently my son has not been using it in school, even with the teachers. Can I still request to have him assessed even though he already has an iPad using touch chat?
Dr. P
Yeah, so if something is being entered into the school setting, and particularly if they're adding it onto the IEP, anywhere in any section, number one, they're responsible for providing that equipment. So your child should be eligible to receive a device through the district that he or she can be using, you know, all day at school, and they have to assess to determine if whatever is being used is helping that student access his or her education, and of course part of that assessment should be collaborating with that outside clinic, right? Assuming you give them consent, which I would recommend doing. So there's consistency. And then making sure there's consistency in the utilization of it across settings, so at school and at home, and that's really why you want to make sure that team is involved and those services are added to the IEP, like who's responsible for updating it when new words need to be added, you know, when they're doing a new lesson plan at school, that language needs to be added on there so your child can participate. Who’s that person, so definitely request an assessment and it should be added in multiple places.
LC
Just because your child already has an iPad doesn't mean that the school then is like great, you’re good! We don’t need to do anything!
Dr. P
That tells me that they're not doing what they should be doing to make sure that he should be accessing it in the way he needs to be during the school day, and they obviously aren't doing training for all the adults that he’s working with on campus, they're not updating it. Definitely, pursue that assessment.
LC
I think you've already mentioned assistive technology, but as we mentioned a lot, it’s an often misunderstood related service. Can you first explain what that encompasses?
Dr. P
Yeah, so assistive technology is pretty much anything the school needs to purchase to ensure that your child has access to the Gen Ed curriculum and/or special ed curriculum, so it can be considered a supplementary service or related service, like an AAC device is more of a related service. Because the individual would then be receiving speech and language to help them navigate that, right. So literally like a pencil grip is considered assistive technology you know, your hearing aids and battery, a calculator, even making charts like special charts for your child, anything that has to be considered technology, low tech right? So yes, your child has an AAC device. For every student who has a device, they should also have a low tech counterpart. Because what if the device breaks, what if the device is dead? What if there’s a power outage and they can’t charge it? So they have to have that low-tech component. Oftentimes, districts don't check the box. They say no, they don't need assistive tech, and then you go to the accommodations page and there's a pencil grip and adaptive paper and a calculator, like all those things are technically assistive technology.
LC
And a lot of those low-tech options you just gave, they can be utilized from an early age onto however long the student may need them. But then when should parents think about the more high-tech or computer assistive technology assessments? Because I know when we started, we asked about it, it was never offered, and then we asked like oh, you should wait until about fourth grade and I know some of the kids are not using computers until that time, but when should parents start thinking about computers and how does that look?
Dr. P
Again, I think it depends on each student and eligibility, like students with vision impairment are going to have access to certain types of assistive tech and low-incidence equipment early on because that’s the nature of their disability. If we're talking about a student who has like a learning disability, like dyslexia is a big one, in which maybe they would benefit more from having access to text to speech and you know, Grammarly extensions and Google Read and Write for you know, supporting like dysgraphia and things like that. I think the general reason you start to see those types of options come out like third grade and after is because reading tends to kind of really stabilize out, if you will, in the sense that if a student is struggling by third grade and fourth grade, they're probably going to continue to struggle pretty heavily, and that's really when you start to see how significantly that struggle is going to be. So oftentimes districts like to try like Response to Intervention and lower-tier interventions up to that point, before kind of saying maybe this student needs an IEP, maybe we should assess, maybe we should look at alternatives. State testing also happens around that time. So you know, I think it's a case-by-case basis, depends on how significant the student is in terms of struggling before then. But you know, if you're feeling like it could be a benefit, then definitely request it.
Adaptive scissors is another assistive technology tool, so either have the OT look at it or have an AT look at it, but it's not just for reading and writing, it’s helping the student access across the board. There are so many things out there we don’t exist, and an AT specialist can be super helpful for that.
LC
And how are those minutes delivered? It’s a little different than OT, PT where you’re getting weekly minutes, or is it not?
Dr. P
No, generally, it is, it’s more of a consult-collab model. They're generally there to assess and kind of make recommendations for equipment, right. So you know, the student is struggling with cutting. Maybe he's had OT for two years and he's stuck on the same goal. Let's look at this different type of too. Or the student has been struggling with reading, he's not making progress. Let's look at this adaptive keyboard, maybe let's try this. So it's not necessarily often that they're going to be providing any direct service as much as just making those recommendations and then training and consulting with the staff to make sure that they know how to properly implement and provide that equipment. That's not to say, like, I have AT specialists written in for monthly minutes, for like a client who has vision impairment and she supports with some of the equipment on going for that to make sure that they're supported, so it’s a case-by-case basis. Definitely AAC, sometimes AAC is under the AT umbrella, it depends on the district and sometimes it’s separate, but, you know, are they going to be providing that ongoing direct support to the student to help them navigate the AAC device or is it going to be the in-house SLP? It just depends on how the district’s model looks.
LC
You just mentioned again, and I know it’s a really important part of IEPs, is that a lot of parents overlook or don't think about and isn’t always offered freely is the training training portion, so you could talk about staff and parent training and how parents should think about that and how they can request that in their IEP?
Dr. P
Yeah, absolutely. So I think the biggest one for me is definitely whenever AAC is recommended, it’s like, okay, when is the training going to happen? Let's schedule it before we end this meeting, what date, how long? Parents need to be there as well and also any in-home providers. Bring your in-home ABA. With AAC, that's literally their voice, usually right? Again, depending on the student, but everyone needs to be consistent and everyone needs to know how that should be utilized. So definitely scheduling that before you leave the meeting with that person because they are generally very busy. There's not many of them.
And then if you feel the need for ongoing, make sure that's written in as a yearly ongoing service. And I also write into my clients’ IEPs that you can use that not only like a beginning of the year training, because obviously at the beginning of the year, there's going to be a new teacher, so we need to keep that up. But anytime a staff leaves, so again, I just had this last week. The SDC teacher left, and now they're searching for a new teacher, and this particular students needs AT not AAC, but we need to have that person trained like as soon as they start so we don't just want to write it as at the beginning of the year, but also anytime a new staff starts, they need to receive that training as soon as possible.
Also, you know, assistive tech because students are going to need to access that at home for homework, so parents need to make sure they know how to support the student and they know what's going on and how their child is learning. So same thing, get that written to the IEP. Just really for any provider, I mean, it doesn't necessarily have to be ongoing. But another thing that's big that I think is frustrating is there's all these, you know, visuals and tools being used at school, and parents have no idea and then they're coming home, the student is coming home, maybe doing homework or what have you, and parents are like well, I didn't know that that's how he was getting through it in the classroom. Can you send a copy for us to use here? So consistency is huge. That may not be training, but consistency. Send home the visuals you're making. What pencil grip does he have a school so I can have one at home? I'll buy my own or whatever, send one home, but making sure parents know they have the right to access all of that, to have it for that student as well, particularly during distance learning too, right?
LC
Someone who's no longer in our district said you know, you don’t need the parent training, assistive technology, you don't need it. She just uses it in school. Doesn't matter. I said I want to come. We want to learn because again, like you said, I think it's really important for parents. You can’t support your child at home for anything they're doing if you have no idea what's happening in school. So think this is one of the most underutilized resources that parents can really write into their IEP is that they can be trained. You can be there, you can be asking questions. And when you're talking about staff, that’s aides too. So if you have an aide, that means that they need to be retrained by whoever it is on whatever it requires.
Dr. P
And that goes for any related service provider. Again, I'll ask in IEPs all the time, like even with the PT, the way they physically prompt and they help guide, can parents come for a few minutes after school when you’re there so you can model that? I mean, you don't necessarily have to have a full training, but those pieces, those little pieces can make such a significant difference. If your child is able to have access to that same type of support all day versus just for, you know, the time they're at school, imagine how much more progress they can make. And it's interesting, my sister lives in Texas, she has autism and anxiety. Texas first of all, they're not called out IEPs they're called ADRs, which totally blew my mind, or ARDs, I'm sorry. But they offer legit in-home parent training like in their programs, like we will come to your house and provide almost like in-home ABA parent consultation through insurance. That's through the IEP. So I'm like, why can't we get that out here? That would be phenomenal, I think for many cases, to kind of bridge that gap right and also, not just because I think parents need it but do you know how many parents if they were allowed to go into the school to support behavior? It would be in mind blow. Like, oh my gosh, I didn't know that's all I had to do.
But parents, like nine times out of ten know how to support their child's behavior better than the behavior specialists, and if they were allowed to go in and say let me show you this, let me model this. Oh my gosh, so many things could be resolved, right, versus us having these meetings, writing these long lists and thinking we know everything. So if the specialist could come into the home and see how things are done, I just think it would be like the biggest help in the world. But I digress.
LC
California, we have some work to do. Let’s do it!
Dr. P
They also allow video cameras in the classroom.
LC
Exactly. Another whole subject that we could talk about. We also just had a question come in from Rhodora, she said can you ask for training with the teacher on the teacher weekly lesson to train the parent on how to implement specifically with their child? Just kind of academic training like whatever they're doing for the week.
Dr. P
I don't think so. Personally, I think that would be asking a lot. I mean, I'm not gonna lie. I mean, to expect a teacher to sit with you every week to over the lesson plan. Imagine how much the teacher is already doing. So I think we also have to be mindful of, like, realistic expectations and what the teachers can handle. I mean, if every student in the class asked for that, that would be a lot. However, you can add front loading of new content or new vocabulary or whatever it is you think a child needs as an accommodation. And then the teacher could then send that information home. Like let's say, you know, they start the new weekly lesson on Monday, then your child would get it sent home on Friday so you can practice and have that exposed a little early, that type of thing.
But yeah, I mean, it's the teacher's job to teach, so they would be the ones that would be responsible for teaching the lessons anyway.
LC
Those are all good points, especially about getting things ahead of time as much as you can even if that's, you know, talking to your child, doing that vocabulary, whether that's coming from the school or you looking at things and things are familiar, whatever support they need would be really helpful. I can say that from personal experience as well.
So one of the biggest related services that parents want to know about is aides. So number one, what kinds of aides are actually available for kids at our schools and number two, how does a child qualify?
Dr. P
I feel like we could do a whole talk just on aides. In a brief summary. One-to-one aides, how those are offered, it’s generally said that it requires an assessment. I personally think an FBA is more useful than kind of generic one-to-one aide assessment, but every district calls it something different, it's literally the same thing. They all use the same rubric. So there's four areas that they look at. And generally the person who completes the assessment is the school psych. But there's really no qualifications for completing this assessment. It's not standardized. It's strictly observation based. And then there's a rubric and it goes from zero to three, I believe. Three being the highest level of need, zero being like the lowest level, so there's health, behavior, instruction, and inclusion, and so health is obviously health, like this a child require medications to be administered at school, or do they have a G-tube or things like that? Behavior is behavior. So looking at, you know, is there a behavior intervention plan? Has there been an FBA? Is there a comprehensive BIP, are there social emotional goals, how is access to instruction in the classroom? And then inclusion is socialization. So those are kind of the four areas, if you kind of take that, that really speaks to the four ways in which an aide can be offering support more or less or the types of aides, right, so there's obviously health aides, like there's going to be students who need either a nurse, that's another related service by the way, nursing support or an aide to support health needs, depending on the severity of those needs. Then there's aides that are specifically implemented and in place to support behavior. So they're there to kind of support the implementation and strategies written into the behavior plan or whatever behavior strategies have been agreed upon within the IEP and to ensure that, you know, those things are kind of being offered when they should be throughout the day. Then there's instructional aides or academic aides, if you will. So those are the aides that are there to kind of help the students stay focused and on task and be redirected and attentive to instruction. They do not teach the students. They are there just to keep the student on task so they can listen and learn from the teacher. And then there’s aides to support socialization. Generally, I don't think I've ever seen an aide that's just for socialization. That's generally because there's like behavior or even just lack of attention and struggle with focus. But they would also, let's say like there's an academic aide, obviously, academics aren't happening on the playground, but maybe that student also requires support socialization, so that same aide would also stay all day, as opposed to just during instructional time, right and also facilitate that social interaction. And aides can also be there on the bus, so they may actually have more minutes than the instructional day if they're starting the bus to school and then taking them home.
LC
Is there a specific training that aides must have to work with kids who have ADHD or ASD?
Dr. P
So that’s a question a lot of parents have. Parents often ask right what credentials or certification or what training an aide has. I'm not going to lie, it ain’t much. I mean, especially right now after COVID, the staff shortages are just monumental. It is so bad, and that's not to say that you should settle by any means. I’m not saying that But just know that there is a huge staff shortage out there. The minimum requirements for an aide is a high school diploma. And then yes, I will say this, depending on the utilization of the aide it's not so much specific to the eligibility as much as it is to the purpose of the aide. So for aides who are there for the purpose of behavior support, they should be receiving a minimum number of hours of like ABA training before they start, you know, whatever student they're supporting in that role. And they should be receiving that ongoing training. Some districts actually have RBT level aides, which is a registered behavior technician under the oversight of BCBAs. So it just depends on the district, but those would be like the deemed behavior aides, right? And their specialization is behavior. So they get that training. Other than that, I mean, obviously, the health aides would have whatever training they need to support that student from the nurse or what have you, but other than that, there's, notlike specific specialized training.
Like let's say your child is fluent in ASL. And they need an aide to support that piece. Or they're not fluent in an ASL but just need some sort of support with that type of interaction. It would kind of fall more under social, but they would get training on how to ensure that they can communicate and interact with your child, right? Or same if your child uses AAC, they would get training on how to support your child and make sure they receive that same level of AAC training that’s written into the IEP. So it's more individualized, but you can request that your provider be educated on how to work with students with autism. Or if you have a specific training you want for ADHD, you can always request it ,but it's not like a requirement for the job.
LC
But what about the instructional aide? Is that something you can get for like a one-on-one instructional aide? Or is that usually a classroom aide that makes sure that your kiddo and the other kiddos, they kind of float around and they come in as needed?
Dr. P
No, you can get a one-to-one aide for the purposes of supporting instruction or academics. So there's like students who have autism or who may have ADHD, those are popular ones in terms of struggling with focus and remaining on task. So it's not so much behavior and that they're, you know, purposely getting up and walking away or not listening to the teacher, or what have you. That’s more what the behavior looks like in this rubric, over a seemingly intentional behavior, whereas with ADHD, it’s part of your disability in the sense that you're going to struggle with being attentive. So you may just need that person there to remind you of things, organization, executive functioning, remembering to grab stuff, remembering to pull things out. Just kind of that level of support. Again, they aren't there to instruct the student per se, they're there to ensure that the student is accessing the instruction of the teacher. Whether or not that's the way it's being utilized, that's a whole nother story, but that's what it should look like.
LC
It's good to know what it should look like. We're also getting a lot of questions. I know this is so common across many districts. What about districts who say that you're not allowed to talk to your aide? I mean, we're just seeing like parents saying this is who’s with my child all day. I'm like, not told their name half the time. Can’t we say that we want to be able to talk to the aide? How can parents deal with that?
Dr. P
I totally get it. I will say I see both sides. Okay, so as a parent or caregiver, I highly recommend that when you do have the opportunity to interact with the aide that you do it in the way that it should be done. Because what's happening is parents are bombarding aides. And I'm not saying all parents, but it happens, and trying to get information out of them and trying to find out what's really going on, and then I get called like, I can't say who told me because she'll get in trouble. But the aide is telling me what's really going on. So obviously that's why this happens. Right? Schools are being held liable. And they're not gonna want interactions with parents and professionals, and it's not just in school, it’s in home.
Think about the dynamic, right? You have the supervisor and you have the therapist, the therapist just like the aide, isn’t as highly qualified and trained in interacting and communication and knowing what to say and what not to say. So they're the lower level tier because they don't have as much of that training and that background and they haven't gone to school for all of that. So that's also part of the reason. They might say the wrong thing. Or they might not use the right terminology, and then parents are going home like oh my gosh, what's happening, and maybe they just said it the wrong way. But on the flip side, you know, parents can be sneaky and try to get information, and then it puts he teacher in an awkward position. Then the aide isn't being utilized properly either. So I get it. You know, you want to know what's really going on with your kid, and I don't hold that against you. I'm a parent. I would want to know too. But going into observations. Send someone else in to do observations if your presence is going to change, you know, your child's performance if they see you. Requests monthly team meetings, have it written into your IEP, you can ask the aide to be there. You can ask the aide to come to the IEP by the way.
Those are the appropriate ways, I think, to have those discussions or asked to talk to the aide with the teacher present. You know, if you have specific questions, those are the right ways to have it be done. It shouldn't be for the purpose of trying to get information out that you otherwise feel you wouldn't have. If that makes sense.
LC
It does. I mean, we had to request that in elementary, and that's exactly what they allowed. It's like, look, this person is in the bathroom with my daughter. There's no way I'm going to let somebody be in situations like that with my daughter without being able to speak to them. So we could have those conversations after class when the teacher was there. But it's hard. You know, as a parent when you feel like you can't talk to anyone. And you know that’s why. Are they gonna say something? But it's such a hard barrier. It feels like it's hard to build trust when you feel like something is being hidden.
Dr. P
Right, and I was just gonna say I feel like it all circles back to trust, but for both sides, right? And then it becomes this cyclical ball of not being able to trust both ways. Whereas you know, I get it. I think that if we looked at it from the perspective of this is a very young person, usually maybe even older, but they aren't necessarily in a position to answer certain questions. But can we speak with the person that does have that credential, have that supervisor there? Make it easy and ask for the aide to come to the IEP. And if it's during the instructional day, you have to be willing to allow your child to have a substitute aide. I mean, just because obviously they're in the IEP. But absolutely, that can happen.
LC
When for aides, especially behavior aides, usually it’s the case, but I guess for any of the services that we're talking about, when is it appropriate for a family to request a private or non public agency to fulfill their child's related service vs. using the district provider or aide? So that could go for any of it, right, OT, PT, behavior.
Dr. P
Another really popular question. Absolutely. It can be any service, not just behavior or the one-to-one aide. The number one time or occasion is obviously when they don't have someone available, so then you would have a contracted outside agency provide that service. So that can be again right now with COVID because they don't have staff, you know, the service provider’s on maternity leave and so they're going to have a gap or, you know, just out of the blue someone leaves, I mean, that happens, life happens. So you can absolutely put in the request for the contracted outside agency if they haven't been able to find someone in, you know, an expected amount of time, and you don't want to just keep building up those full comp time hours, and obviously simultaneously your child is just not receiving that service. That's not okay. Definitely the most popular request I get is for the one-to-one aide to be provided through an outside nonpublic agency. And usually for the purposes of behavior, that behavior type aide. Generally because of that trust, you know, they prefer their in-home agency to also provide that one-to-one support, or they just feel that, you know, outside agencies are better apt to provide that level of service. And so it depends on the student, obviously it's a case-by-case basis, but generally what the answer is, is the district always has the right to provide their own personnel first to provide that service. If and when it comes to be that that inside or in-house personnel isn't equipped or is unable to provide the service that's allowing meaningful progress for your child, then you have more of a leg to stand on to kind of say, look, we tried your people, it's not working. My child's behavior isn't getting any better. We want to go with this outside non public agency.
LC
Which also can be hard, I guess another trust thing that comes in, but then they can send whatever aide they want, like if you start with their aides. It's a common thought with parents, right? Like you want to make sure that your kid’s getting what they need from the beginning. It's hard. And I know you're right, for a lot of things, it's like let's just try it. But it is so hard to know that you're setting above a lot of times for possible massive failure before they can get what they need.
Dr. P
I mean, to be fair, I will say there's also downsides to having an outside agency.
I mean, I feel like I have sort of a benefit coming in because I'm a behaviorist. And I'm also somewhat non traditional. I'm not like a super radical behaviorist who thinks we need to whip kids into shape and be like the rest of us by any means. I'm very much the opposite of that. But I'm obviously very well educated and well versed on it, and so I kind of am able to see things that probably most people couldn't. So I think most of my clients who have ever requested it have gotten it because I have the argument that they need. But I also am very well able to see when districts are doing a good job. And I do think that you know, it's hard. I have those conversations often with parents, not just for behavior, for anything. Like say you're telling me that my kid needs to bail first or we need to let them fail on my child? And it's like, no, not necessarily. I mean, I know it sounds that way and to an extent, maybe a little bit, but we definitely don't need to let it go on for too long, for sure. You just have to know what to ask for. And you have to be on top of it and make sure you're holding them accountable to get you that data every week. And make sure the data looks solid and sound, and if there's any question, go in and observe. You know, it does sound frustrating, but it works. There are often occasions in which the staff are great. I mean, I don't agree that it should always be an outside agency. There are many district staff who are phenomenal and they do a great job, and sometimes when you just have that person coming in to hold them accountable, maybe they're doing a little bit better job and that's not right. But they're doing it and they're doing it well.
LC
Is the goal to reduce services as the years go on?
Dr. P
Related services?
LC
Yeah, yes. Like OT, PT, speech. I know when we started it was like, just know that the whole goal is that your kid gets less every year. At the beginning, it's like okay. I've heard that enough times, but as she's getting older, these needs don't go away. She's not growing out of it. If anything, like as things get more challenging, they can need more support. Or if you're trying to do inclusion and they need those supports. Whatever it might look like. It's a common myth that parents are told when they're starting this journey. So I’d love your thoughts on that?
Dr. P
I think I see that a lot with OT personally more than any other service. It's like, well, we've been working on writing her name for the past three years, and it's not working so we're not going to provide service anymore. It’s like wait, what? No, the goal is definitely not I guess to get rid of related services. I mean, I guess I would say the goal would always be for the student to have access to their least restrictive environment, right. And so, yes, the more services they have that are not within their general education setting, they're being pulled out and not in the least restrictive environment, but the student needs what the student needs. And so if a student is working on the same skill year after year after year, obviously something isn't working, right. We don't just want to keep doing that over and over and over, but you're right. Needs should change because as students age up, they're doing different things. And so it may be the case that yes, OT isn't needed anymore for writing her name. But now she's in high school and she's using the Chromebook more and we need to work on typing and learning how to navigate this, that, and the other. So yeah, if there's a need, then the student should have access to the service. But if there's no longer a need, then that's not a bad thing. Right. And maybe it's just consult and collab. It's again a case-by-case basis.
LC
How do we know what our kids are working on or if they're actually getting the minutes that are in the IEP?
Dr. P
Yes, another great question. So for related services, specifically, you definitely have the right to request the data. First of all, look at your IEP goals. If it's ever something that's tangible, always make sure that they're written as measured by work samples, because then the data will always be the work that they're doing. So if the OT goals are any form of writing or typing, technically that's a work sample too, you can literally receive that as the proof right? Now, if it's a goal where it can't be tangible, like a counseling goal, and they're talking and giving, you know, talking about coping, that's different. It's a little harder. Ask for service logs, you have the right to the service logs, and the service logs aren't as great as like real data, but it'll still have the date and the time and what they worked on and you can you can gauge that. I told you guys in a Facebook Live we had a while back, the OT literally claimed they had sessions and we check the dates and they were Sundays. So you never know. You might find stuff that you are like, shocking.
LC
You were so excited for that moment of the IEP to point that out, right?
Dr. P
Service logs, data. Obviously, if your child is able to just straight up tell you, that’s the best, like I haven't seen that person since last year, like Oh, great. Okay, that's happened to me twice in the past week. Again, observations. You have the right to observe speech and language sessions. If they're in group, that's still a public school, you can still go in and observe a public speech and language session. If they're in a social skills group, you can still go in and observe. If they’re in an OT group, you can still go in and observe, and again if your presence will change your child's behavior, send a blind observer, someone that they don't know is there for them that you trust, obviously.
LC
We're coming up on time, but we'll do this as fast as we can. There's a couple things I definitely want to hit on. One is push in versus pull out. You know, how should parents think about service minutes? You know, with those two things in mind, what should they think about when making decisions?
Dr. P
Yeah, so push in is obvious is when the provider’s going into the general education, I guess, whatever classroom your child is in and providing the service there, whereas pullout is they're being removed from their classroom to meet with that service provider, generally in their location, or if it’s PT maybe it’s on the campus or whatever, possibly. So when it's pushed in, and it's push in into the Gen Ed class, that's not going to change their percentage of time in Gen Ed. So that's one thing to be aware of. But also, in terms of whether or not it's going to be beneficial for your child. Is your child able to focus and are they able to learn whatever skill they're working on whatever that goal is that they're working on in that type of environment? If your child gets very distracted or they lose focus or you feel like it wouldn't be intensive enough, like practice, you know, you're going to opt for more of a pullout model.
And the same is kind of to be said for should it be individual or group like with speech language, that's a big one. I feel like my child needs one-on-one. Why are you offering group only? You know, there are occasions in which it makes sense. Obviously, if it's a social goal, they should be with peers, not with themselves. But also be mindful that, you know, there's shortages, and unfortunately there are providers out there that are trying to push just group because they don't have the time to see kids one on one, and if your child needs one on one then push from one on one.
LC
Can a school refuse to do push in? Like I hear that a lot with inclusion, right? If kids or parents are trying to hit their kid in a gen ed class, it's like well, we can't do that because we have to pull them out. Or when pulling them out, which I guess is a different question, when can we ask for times that they can or can't be pulled out? Okay, two questions. Can a school refuse to do push in?
Dr. P
Can a school refuse to do push in for inclusion?
LC
For any service, like if they say no, we have to pull you out and take you to the therapist room. We can't really do this in a class. A lot of parents, they don't want their kids to miss class, you know, with whatever class they're in and they want them to be getting that service within the class. And then there's others that are completely opposite depending on the kiddo’s needs. So can the school say nope, we can't. We're not going to do push in. We have to pull them out.
Dr. P
If the provider’s pushing in, and especially if we're talking about a gen ed class, I mean, really any class, but they're going to be working on whatever the teacher is teaching at that time. So like, let's say, the OT is pushing in and they're working on typing. It would make sense that the OT would go in during an instructional time in which the class is working on typing an essay, let's say. They wouldn't go in when they're doing math. And they're not pushing in to work with your child like in the corner, one on one, they're going to be pushing in to work with whatever's being done that makes sense for that goal. If there isn't something that's being worked on, anytime during the day, that would make sense. Like let's say your child is mainstreamed. In fifth grade. Maybe they're working on writing his or her name. That's not the best example. But yes, you could write a name, but like how many times are you going to write your name for a 20 minute session push in? The OT can't like completely veer off from what's being done in class, then it wouldn't make sense. That, to me, would be more of a need for pullout. They cannot deny push in, but it has to make sense based on what the goals are in the IEP and can that be worked into that push in setting if that makes sense?
LC
Yeah, yeah. And for pull out, can we stipulate times that we don't want our child pulled out?
Dr. P
Yeah. Like obviously wouldn't want your kid being pulled out from really important core academic time, right? You want to make sure they're not missing that core academics. So generally, particularly in like middle school in high school, specialists are really good at pulling from P.E. or elective time. And oftentimes, students don't prefer that because that tends to be the more fun classes for them. But then simultaneously, if they were pulled during those core academic subjects, they're missing a lot for that 20 minutes, and then they're behind, so absolutely. The same can be worked around in elementary school. You know, it's obviously a little different because it's one teacher all day. So you just look at the times. And if the provider is like, sorry, I already have my schedule yet, say sorry, that's not my problem. Like my child needs to be seen during whatever other times, let's make it work.
LC
And definitely put that, because I think a lot of things like well, we just sort of do whatever we can because there's so many kids, but you can really push and say absolutely not, we don’t want them pulled out at that time.
Dr. P
Because it’s impacting them, and then they're going to be behind in the other area that they're already behind in, and that’s not helpful.
LC
Really quickly. I know we're already over time, but we kind of hit on some of the lesser known, you know, related services. DHH we talked about, O and M, OI, low vision. I just threw out a bunch of acronyms. So just really like, quickly touch on those. And then I have a follow up.
Dr. P
Recreation and Leisure is probably my favorite secret one. It’s an assessment that I don't think most districts have a real designated person to conduct. But that's really to look at, like social skills and just ways in which a student can benefit socially, recreationally during leisure skills and leisure time. So that's a really fun one. If you have a student who's struggling maybe at recess or you know at middle school. So hard, right? They don't have a playground anymore. And it's like, what do my kids do now? Like they're struggling with communication socially. So that's a great one. Look it up if you're not familiar with that. Adaptive PE if your kid is struggling with gross motor, and you can get that as early as kindergarten, it doesn't have to wait until like, there’s a designated PE class. It can be as early as kindergarten to support like that gross motor development. OI, that's orthopedic impairment. So whenever a student is designated, or they qualify under that eligibility orthopedic impairment, they should have an OI specialist attached to their IEP. It's not necessarily a direct service, but they basically kind of are the expert, if you will, in that eligibility category and kind of help, you know, support whatever needs that student may have.
If a student qualifies under vision impairment, then they can also be considered for orientation and mobility services, but the only way you can access O and M is if you qualify for vision services. So, O and M is kind of different from PT in that they're helping the student navigate as it relates to their vision, if that makes sense. So like if a student has a walking cane, then they can help them learn how to utilize that and navigate even off campus, as an example. Even if they don't have the walking cane, necessarily, but they can still help learn how to go like up and down the curve or up and down the stairs. A bit down to more for the vision, not so much like the physical motor reason.
DHH, Deaf and hard of hearing, so if your student qualifies under DHH, then they would have the DHH service provider and again, helping with if they have hearing aids or like a pass mic. So, if there's the FM system and then also like a pass mic that can be passed around because yes a teacher is wearing that, but what about when the peers raise their hand and they speak within class, if the student can't hear them then how is that helpful? So just making sure your student has accessibility to everything within the classroom that they should be. We talked about AT, AAC.
LC
And then I want to ask just about two educational things. Educational therapy. Is that a related service? And then inclusion specialist.
Dr. P
Oh, yeah. I was gonna say inclusion specialist. I'll answer that one first. So an inclusion specialist can also be an additional layer of support. A hidden gem, if you will. Most districts still don't have one, which I think is definitely probably the most necessary support that every district should have at least one of They should be a moderate to severe credentialed special education teacher, ideally having extensive knowledge and experience and background and like both gen ed and special ed curriculum, and how to provide that inclusionary support. So they would consult with the gen ed teacher and go in and help the gen ed teacher basically incorporate your child's goals into their everyday classroom. And also help the gen ed teacher modify the Gen Ed curriculum so that your child can access that curriculum. And it's just amazing to have that support. And yes, they can be written into the IEP. And if your district doesn't have one, yes, you can have them contract out. There aren't many, but they do exist. They're like unicorns. Education therapists.
LC
Yeah, we have some people ask about education therapy or tutoring.
Dr. P
Now, so I get that a lot. The argument can be made to have the district reimburse you for tutoring. If you can prove that there's a rationale for that, but other than getting like compensatory education, their tutoring wouldn't be written into the IEP.
LC
Okay, looking I know we're over. But I really like your idea of doing a separate session on aides as well. So there's, there's a lot to unpack. And you did an amazing job. Thank you so much. I know a lot us think of the big services, like you know, OT, PT, and speech, but many of those lesser known services are not discussed, like you said, or they're frequently misrepresented.
Dr. P
Yeah, that one counseling. Counseling is another one. If you feel like your child would benefit from counseling, there's definitely like the basic school counselor, which may work, and then there's, like out here we have kind of like free, county-based type counselors that are interns, and the turnover is insane. It's not great, right? And then there's intensive, individualized counseling. And so that's with a licensed therapist. Out here we call it ERSES or ERMHS, educationally related social emotional services or educationally related mental health services. And that would be with like a licensed MFT or licensed social worker. And then once you're qualified for that level of service, it also opens the door for COEDS wraparound services. So if a child is struggling like socially emotionally, and that may be manifesting behaviorally as well, both in the home and in school, kind of going back a little bit to Parent Training COEDS, there's different tiers, one of which provides a parent partner, a student partner, and then a case manager. And you have like weekly meetings, and then the student partner can see the student home and at school, and that's pretty accessible in most districts that I've seen. Some districts try to tell you, you have to do that your insurance and it's not true. If your child needs it for educational purposes, then the district should be funding that and it can be written as a related service. And it can be really, really helpful.
LC
And I know ours can be accessed through our SELPA. ERICS is what it's called. It is very little known. I know a lot of who parents have experienced it. It's made a huge difference for them.
Dr. P
And you don’t have to have an emotional disturbance eligibility. Any eligibility.
LC
I mean, I've known kids with extreme anxiety to where they don’t want to go to school. It's been, you know, hugely helpful. So definitely something to ask about, so thank you for pointing this out for sure. It's a lot, right? Somebody asked like, is there a menu right? That's a question for everything that we talked about, is there like a menu of services somewhere? We're definitely going to be working on, not that there's this perfect like menu, but based on our talk today, we're going to be putting together an article. We'll be following up with Dr. Pelangka to really spell all of this out. And hopefully you know, you can access something, other than rewatching this, to really look at something and think Alright, what do we need to ask about, what are the questions I need to ask when going into the IEP about what support my child? Because there is so much out there that you don't know that you might not know about the good help, and sometimes your district isn’t utilizing them in the right way or they’re not thinking about it in that way for your child. So it's important to ask those questions. If you do want more, deeper support, and a one on one guide to talk through what services your child is or isn't receiving, our Undivided Navigators would love to help you through it, to help access the experts, to really bring the options to the table and talk those through with you.
To find out more information on how Undivided can support you in preparing for all your child's IEP requests, check out our free 30-day Kickstart. I know our Navigators, many of them are also parents, would love to meet you. And our mission is to support you so your children can thrive. Please reach out and let us know how we can help.
