Introduction

Special education is the process by which students with special needs receive education via the process of addressing their differences while integrating them as much as possible in the typical educational environment of their peers. Success, measured as self-sufficiency, academic achievement, and future contributions to the community, may not be achieved if students with special needs do not receive this additional help. In the United States and many other countries, children who have special educational needs are entitled by law to receive services and accommodations that will help them perform to the best of their abilities and reach their academic potential.[1][2]

Special needs can include learning disabilities, speech and language impairments, autism spectrum disorders, cognitive impairments, emotional and behavioral disorders, physical disabilities like cerebral palsy, muscular dystrophies, sensory impairments like vision or hearing, chronic medical illnesses, and any condition that affects optimal education. Whenever possible, the needs of these students should be met in the same environment where other peers learn. Only when progress is lacking in this mainstream setting, then a different classroom placement can be selected for their education. This new setting may include fewer students in the classroom, more teachers, or a higher level of support. The process of moving a child from the typical classroom or educational setting to a specially structured one is gradual. Emphasis should focus on finding the balance of meeting the students' educational needs in the least restrictive environment.[3]

Function

Background History

Beginning in 1975 the All Handicapped Children Act (PL 94-142), and later evolving into the Individuals with Disabilities Education Act (IDEA,1990), No Child Left Behind, and most recently the IDEA improvement act 2004, federal laws in the United States have ruled that public schools must provide free, appropriate public education (FAPE) to students with disabilities. Any person between 3 to 21 years of age suspected of having a disability is entitled to a comprehensive, interprofessional evaluation, and if eligible, to an individualized learning plan, and monitoring over time, showing the achievement of adequate progress. Part C of the law includes the educational services provided to children from birth to 3 years in a program called Early Intervention Program (EIP). [4]

Role of the Medical Provider

The medical provider has an indirect but important role in supporting the education of their patients. This role includes early identification of students who struggle in school, encouraging families to ask the schools for help, supporting them through the process, providing medical documentation when necessary, and becoming involved in advocacy efforts at the individual and community level.

Issues of Concern

Common Terms Used in Special Education

1. General education: Standard curriculum without any special arrangements or modifications
2. Mainstreaming: The environment in which students typically receive their education; the same as general education. Teachers accommodate the curriculum for group instruction.
3. Response To Intervention (RTI): Initial interventions used by general education teachers in a regular classroom to help struggling students, those who are falling behind. This process is put in place and monitored to see how much the student benefits from it before more formal evaluations that may lead to an Individual Education Plan (IEP).
4. Individualized Education Program (IEP): Legally binding document by which the public school system, after an interprofessional evaluation, identifies the educational needs of a student the intervention that will help achieve this goal and the method for monitoring of progress.
5. Individuals with Disabilities Education Act (IDEA): Federal law that requires public schools to provide special education services for children ages 3 to 21 who meet specific eligibility criteria
6. Free Appropriate Public Education (FAPE): The educational right of students with disabilities to be educated at public expense, and make adequate progress.
7. Remediation: Interventions given to help the student who has fallen behind academically for whatever reason, to catch up. The student may or may not have special needs, or their special needs may not have been identified.
8. Accommodations: Include all the adaptations that will improve the student's academic success, like extra time for assignments or exams, use of technology, or adaptive equipment.
9. 504 modifications/accommodations: Adaptations, modifications, or accommodations to the curriculum based on a medical diagnosis. It is usually used when the student doesn't qualify for an IEP. It will provide many similar interventions and support.
10. Related services: Interventions that are not strictly educational but will help the student benefit from the overall educational support that he/she is receiving. May include counseling, occupational therapy, physical therapy, speech and language therapy, transportation, among others.
11. EIP (Early Intervention Program): Educational services provided to children from birth to 3 years old who either have a significant developmental delay or who are at risk for a delay.
12. CPSE (Committee for Preschool Special Education): Educational services provided to children 3 to 5 years old with educational needs.
13. CSE (Committee for Special Education): Educational services for children 5 to 18 or 21 who have academic needs. 

Evaluation Process

The process of providing educational interventions tailored to the individual needs of students consists of multiple steps. The process begins with the identification of students' educational needs. Educators are mandated to recognize students who struggle and those whose needs are not being met. After identifying a struggling student, the family must consent to the evaluation. These students then receive an RTI. In this part of the process, a personalized set of interventions is designed and put in place. The response to these interventions is monitored over a pre-determined period. If the student can catch up with the rest of the class, no further evaluation is necessary at this time. However, if there is no progress, then an interprofessional evaluation is done by the school assessment team. As a result of the evaluation, a decision will be made if the student has needs that will make him/her eligible for an IEP. The student that meets the criteria to qualify is eligible for the services. The degree of delays or educational needs that make students eligible for services varies by state and local legislation. The individual needs of the student, how to address these weaknesses, how to monitor progress, and clear goals for achievement over time are put together into a document called the IEP. This process includes procedural safeguards that ensure the rights of the children and their families, as well as a due process if there is no provision of these services.[5]

After an IEP is put in place, and the additional educational support starts, the student's progress is followed over time. Extra help usually begins in the general classroom setting. After a period, if the student does not make adequate progress and further support is necessary, then the student is placed in a more structured educational environment. This educational setting can be in an inclusive or collaborative team classroom, where students with and without IEPs are educated together by a teacher in cooperation with a special education teacher, or in smaller classrooms, sometimes called self-contained classes, where all the students have special needs. In some cases, adequate placement may be in a different school out of their home school district.

A similar process exists for preschool-age children. Preschool children, 3 to 5 years old, are provided with educational services by the Committee for Preschool Special education, following an interprofessional evaluation that determines their eligibility. Children younger than three years old receive services by Early Intervention, part C of the IDEA. Children with their families undergo evaluation by a comprehensive, interprofessional, and family-centered assessment. An Individualized Family Service Plan (IFSP) will then be developed.

Similarly, this plan includes educational goals. And it states how their educational needs will be addressed. It will also include ways to measure the child's progress and plans to transition the child to preschool services if the continuation of services is needed.

Clinical Significance

Early identification and proper remediation of developmental delays in young children and learning difficulties in older students have lifelong benefits. Students will achieve higher academic levels and financial independence. Many studies have shown that students with unidentified educational needs experience negative labeling, like being called lazy or dumb. They experience feelings of frustration, shame, and can develop anxiety, poor self-esteem, a higher rate of substance abuse, school dropout, and juvenile delinquency. [6][7][8]

Special education programs are put in place for those students who are mentally, physically, socially, and/or emotionally delayed. This aspect of "delay," categorized broadly as a developmental delay, signify an aspect of the child's overall development (physical, cognitive, scholastic skills) that place them behind their peers. Due to these special requirements, students' needs cannot be met within the traditional classroom environment.[9]

Other Issues

504 Modifications

When a student has a medical diagnosis but is not eligible for special education, schools can make accommodations or adaptations to provide support under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (ADA). For example, if academically, they are at grade level but have a medical condition (attention deficit hyperactivity disorder) that prevents them from performing to the best of their potential. Under this provision, there cannot be discrimination against people with disabilities, and equal opportunities must be available. For school purposes, this means that “reasonable accommodations” must be made to compensate for the deficits due to the medical condition of the individual, including modifications for participation in the classroom, testing, transportation, and childcare.

Gifted Education

Children who are performing above the expected and are considered gifted and talented may need specialized teaching, but this is usually not included in special education. Gifted students are not eligible for an IEP.[10]

Enhancing Healthcare Team Outcomes

Students with special educational needs due to medical conditions need optimal health care. Optimizing medical care for those students will improve their educational outcomes. Routine assessment and long-term planning and treatment are essential components of health care and eventually educational outcome. Technology has played an increasingly important role in the health care and learning process of special needs students. Diversity of tools and devices became available to improve the function of impaired body systems like hearing, sensing, visualizing, vocalizing, ambulating, and writing or communicating. Learning, in general, has also made important forward steps using technology. Availability of advanced audio-visual devices and learning objects, fast and highly efficient communication devices and routes, distant education concepts and tools, and the needed expertise gave a new meaning and set up new higher goals of education.