The Link Between Medicaid and the Individuals with Disabilities Education Act (IDEA): Recent History and Current Issues

[From Summary] As a condition of accepting funds under IDEA, public schools must provide special education and related services necessary for children with disabilities to benefit from a public education. Generally, states can finance only a portion of these costs with federal IDEA funds. Medicaid, the federal-state program that finances medical and health services for the poor, can cover IDEA required health-related services for enrolled children as well as related administrative activities (e.g., outreach for Medicaid enrollment purposes, medical care coordination/monitoring). However, the link between IDEA and Medicaid has not been seamless. Despite written federal guidance, schools have a difficult time meeting the myriad complex reimbursement rules applicable to all Medicaid participating providers. According to federal investigations and congressional hearings, Medicaid payments to schools have sometimes been improper. The President’s FY2007 budget proposal would prohibit federal Medicaid reimbursement for IDEA-related school-based administration and transportation costs. This report will be updated.

Specific language impairment in pre-adolescence, adolescence, and adulthood with special emphasis on health-related quality of life

This clinical study focused on effects of childhood specific language impairment (SLI) on daily functioning in late life. SLI is a neurobiological disorder with genetic predisposition and manifests as poor language production or comprehension or both in a child with age-level non-verbal intelligence and no other known cause for deficient language development. The prevalence rate of around 7% puts it among the most prevalent developmental disorders in childhood. Negative long-term effects, such as problems in learning and behavior, are frequent. In follow-up studies the focus has seldom been on self-perception of daily functioning and participation, which are considered important in the International Classification of Functioning, Disability, and Health (ICF). To investigate the self-perceived aspects of everyday functioning in individuals with childhood receptive SLI compared with age- and gender-matched control populations, the 15D, 16D, and 17D health-related quality of life (HRQoL) questionnaires were applied. These generic questionnaires include 15, 16, and 17 dimensions, respectively, and give both a single index score and a profile with values on each dimension. Information on different life domains (rehabilitation, education, employment etc.) from each age-group was collected with separate questionnaires. The study groups comprised adults, adolescents (12-16 years), and pre-adolescents (8-11 years) who had received a diagnosis of receptive SLI and had been examined, usually before school age, at the Department of Phoniatrics of Helsinki University Central Hospital, where children with language deficits caused by various etiologies are examined and treated by a multidisciplinary team. The adult respondents included 33 subjects with a mean age of 34 years. Measured with 15D, the subjects perceived their HRQoL to be nearly as good as that of their controls, but on the dimensions of speech, usual activities, mental functioning, and distress they were significantly worse off. They significantly more often lived with their parents (19%) or were pensioned (26%) than the adult Finnish population on average. Adults with self-perceived problems in finding words and in remembering instructions, manifestations of persistent language impairment, showed inferior every day functioning to the rest of the study group. Of the adolescents and pre-adolescents, 48 and 51, respectively, responded. The majority in both groups had received special education or extra educational support at school. They all had attended speech therapy at some point; at the time of the study only one adolescent, but every third pre-adolescent still received speech therapy. The 16D score of the adolescent or the 17D score of the pre-adolescents did not differ from that of their controls. The 16D profiles differed on some dimensions; subjects were significantly worse off on the dimension of mental functioning, but better off on the dimension of vitality than controls. Of the 17D dimensions, the study group was significantly worse off on speech, whereas the control group reported significantly more problems in sleeping. Of the childhood performance measures investigated, low verbal intelligence quotient (VIQ), which is often considered to reflect receptive language impairment, was in adults subjects significantly associated with some of the self-perceived problems, such as problems in usual activities and mental functioning. The 15D, 16D, and 17D questionnaires served well in measuring self-perceived HRQoL. Such standardized measures with population values are especially important in confirming with the ICF guidelines. In the future these questionnaires could perhaps be used on a more individual level in follow-up of children in clinics, and even in special schools and classes, to detect those children at greatest risk of negative long-term effects and perhaps diminished well-being regarding daily functioning and participation.

Inclusive education policy, the general allocation model and dilemmas of practice in primary schools

Background: Inclusive education is central to contemporary discourse internationally reflecting societies’ wider commitment to social inclusion. Education has witnessed transforming approaches that have created differing distributions of power, resource allocation and accountability. Multiple actors are being forced to consider changes to how key services and supports are organised. This research constitutes a case study situated within this broader social service dilemma of how to distribute finite resources equitably to meet individual need, while advancing inclusion. It focuses on the national directive with regard to inclusive educational practice for primary schools, Department of Education and Science Special Education Circular 02/05, which introduced the General Allocation Model (GAM) within the legislative context of the Education of Persons with Special Educational Needs (EPSEN) Act (Government of Ireland, 2004). This research could help to inform policy with ‘facts about what is happening on the ground’ (Quinn, 2013). Research Aims: The research set out to unearth the assumptions and definitions embedded within the policy document, to analyse how those who are at the coalface of policy, and who interface with multiple interests in primary schools, understand the GAM and respond to it, and to investigate its effects on students and their education. It examines student outcomes in the primary schools where the GAM was investigated. Methods and Sample The post-structural study acknowledges the importance of policy analysis which explicitly links the ‘bigger worlds’ of global and national policy contexts to the ‘smaller worlds’ of policies and practices within schools and classrooms. This study insists upon taking the detail seriously (Ozga, 1990). A mixed methods approach to data collection and analysis is applied. In order to secure the perspectives of key stakeholders, semi-structured interviews were conducted with primary school principals, class teachers and learning support/resource teachers (n=14) in three distinct mainstream, non-DEIS schools. Data from the schools and their environs provided a profile of students. The researcher then used the Pobal Maps Facility (available at www.pobal.ie) to identify the Small Area (SA) in which each student resides, and to assign values to each address based on the Pobal HP Deprivation Index (Haase and Pratschke, 2012). Analysis of the datasets, guided by the conceptual framework of the policy cycle (Ball, 1994), revealed a number of significant themes. Results: Data illustrate that the main model to support student need is withdrawal from the classroom under policy that espouses inclusion. Quantitative data, in particular, highlighted an association between segregated practice and lower socioeconomic status (LSES) backgrounds of students. Up to 83% of the students in special education programmes are from lower socio-economic status (LSES) backgrounds. In some schools 94% of students from LSES backgrounds are withdrawn from classrooms daily for special education. While the internal processes of schooling are not solely to blame for class inequalities, this study reveals the power of professionals to order children in school, which has implications for segregated special education practice. Such agency on the part of key actors in the context of practice relates to ‘local constructions of dis/ability’, which is influenced by teacher habitus (Bourdieu, 1984). The researcher contends that inclusive education has not resulted in positive outcomes for students from LSES backgrounds because it is built on faulty assumptions that focus on a psycho-medical perspective of dis/ability, that is, placement decisions do not consider the intersectionality of dis/ability with class or culture. This study argues that the student need for support is better understood as ‘home/school discontinuity’ not ‘disability’. Moreover, the study unearths the power of some parents to use social and cultural capital to ensure eligibility to enhanced resources. Therefore, a hierarchical system has developed in mainstream schools as a result of funding models to support need in inclusive settings. Furthermore, all schools in the study are ‘ordinary’ schools yet participants acknowledged that some schools are more ‘advantaged’, which may suggest that ‘ordinary’ schools serve to ‘bury class’ (Reay, 2010) as a key marker in allocating resources. The research suggests that general allocation models of funding to meet the needs of students demands a systematic approach grounded in reallocating funds from where they have less benefit to where they have more. The calculation of the composite Haase Value in respect of the student cohort in receipt of special education support adopted for this study could be usefully applied at a national level to ensure that the greatest level of support is targeted at greatest need. Conclusion: In summary, the study reveals that existing structures constrain and enable agents, whose interactions produce intended and unintended consequences. The study suggests that policy should be viewed as a continuous and evolving cycle (Ball, 1994) where actors in each of the social contexts have a shared responsibility in the evolution of education that is equitable, excellent and inclusive.

Inclusive education: exploring teachers' perspectives /

This study explores 5 teachers' perspectives on inclusive education. The literature reviewed gives a historical background of special education as well as discusses a number of current methods and techniques that have been implemented as a means to include exceptional students in regular classroom settings. This is a qualitative study that collected and interpreted data in narrative form. Common themes emerged from the accounts that were shared by the participants. This study found that the understanding of mUltiple intelligences and differentiated instruction might assist a teacher to better meet the needs of exceptional students within inclusive classrooms. Based on this study, it is determined that a range of considerations needs to be weighed when choosing an educational placement for a student with an exceptionality. Each decision needs to be based on the individual student and the options open to himlher. When a decision about class placement is to be made, not only are the student's strengths and needs to be considered, but also the school and community, the teacher, and the parents' desire for their child must be taken into account. More work still needs to be done around inclusive education that is at the practical level, so that the needs of both the student and the teacher can be met. Inclusive education did not mean the same thing to each person. It was individualized, just as each student is an individual and what works best for himlher is individual. In learning about inclusive education, settings and strategies need to be considered to allow for each individual student to achieve hislher personal best.

Making the transition from secondary to post-secondary education : a retrospective study of students with learning disabilities

The purpose of this study was to investigate what students with Learning Disabilities perceive are the personal characteristics they possess and services they require to assist them to complete secondary school and to continue their education in a postsecondary setting. Twenty-one students (12 female and 9 male) participated in the study which consisted of an interview and completion of a questionnaire. The central findings were as follows: 1) the participants perceived that personal characteristics were important in secondary school and still remain of importance at th~ postsecondary level; 2) Many of the typical accommodations and services supposed to be provided in secondary schools were not provided to the participants in this study; 3) the participants believed that they had more academic than social problems. Recommendations for future research in this field are based on findings related to the transition of LD students from secondary school to postsecondary education.

Departmental differences in attitudes to special educational needs in the secondary school

As trends in favour of inclusion continue, questions arise concerning the extent to which teachers in mainstream schools feel prepared for the task of meeting pupils' special educational needs. Little previous research has considered how the subject taught impacts upon the attitudes of mainstream teachers towards pupils with special educational needs. In this article, Jean Ellins, research fellow at the University of Birmingham, and Jill Porter, senior lecturer at the University of Bath, report on their research into the attitudes of teachers in one mainstream secondary school. Building a detailed case study using documents, records of pupil progress, an interview and a questionnaire using a Likert-type attitude scale and open-ended questions, these researchers set out to explore distinctions between the attitudes of teachers working in different departments. Their findings suggest that the teachers of the core subjects, English, mathematics and science, had less positive attitudes than their colleagues. Further, pupils with special educational needs made least progress in science where teacher attitudes were the least positive. Jean Ellins and Jill Porter review the implications of these findings and make recommendations for future practice and further enquiry.

Who Should do What to Whom? : Occupational Groups´Views on Special Needs

The overall aim of this thesis is to increase our knowledge of different occupational groups´ views on work with children in need of special support. This is explored in four separate studies. The first study investigates the views of occupational groups in preschools and schools in one municipality. A questionnaire was handed out to all personnel (N=1297) in the municipality in 2008 (72.5 % response rate). The second study explores the views of educational leaders (N=45) in the same municipality. Questionnaire # 2 was distributed in 2009. All the educational leaders responded to the questionnaire. The third study describes the views of different occupational groups concerning special educational needs coordinators´ (SENCOs) role and work. This was highlighted by comparing responses from questionnaire #1 and # 2. Responses concerning SENCOs´ work were also added using a third questionnaire. This questionnaire was handed out in 2006 to chief education officers (N=290) in all municipalities in Sweden. The response rate was 90.3%. Finally, the fourth study presents five head teachers´ descriptions of their work with special needs issues. Study four was a follow-up study of questionnaire # 2. These head teachers were selected because of their inclusive values and because they seemed to be effective according to certain criteria. They were interviewed in January 2012. The results reveal a number of interesting findings. For example, there are both similar and different views among the occupational groups concerning work with children in need of special support. A majority of the respondents in all groups state that children´s individual deficiencies is one common reason why children need special support in preschools/schools. Differences between the occupational groups become especially visible regarding their views of SENCOs‟ work. Critical pragmatism (Cherryholmes, 1988) is applied as a theoretical point of departure. Skrtic´s (1991) critical reading and analysis of special education relative to general education is specifically used to interpret and discuss the outcome of the studies. Additionally, Abbott´s (1988) reasoning concerning the “division of expert labor” is used to discuss the occupational groups´ replies concerning “who should do what to whom”. The findings in the studies are contextualized and theoretically interpreted in the separate articles. However in the first part of this thesis (in Swedish: Kappa), the theoretical interpretations of the empirical outcome are discussed in more detail and the results are further contextualized and synthesised. Inclusion and premises for inclusive education are also discussed in more depth in the first part of the present thesis.

Applying social critical literacy theory to deaf education

This article explores social critical literacy theory and its application to deaf education. It argues that critical literacy offers an approach that can lead to engagement with and empowerment over written text, repositioning students as researchers of language. Texts that represent deaf people - if only through their absence - offer an opportunity for deaf students to engage in literate practices in meaningful contexts. An example of critical text analysis is provided using articles on a contested issue: cochlear implantation.

Mathematical power of special-needs pupils : an ICT-based dynamic assessment format to reveal weak pupils' learning potential

This paper reports a study aimed at revealing special-educational-needs pupils' learning potential by means of an ICT-based assessment including a dynamic visual tool that might help pupils when solving mathematics problems. The study focused on subtraction problems up to 100, which require 'borrowing'. These problems, in which the value of the ones-digit of the subtrahend is larger than the ones-digit of the minuend, are known as a serious difficulty for weak pupils in mathematics. Seven of such problems from a standardised test were placed in the ICT environment. Data were collected from two test conditions: the standardised written test format and the ICT version of the test items including the tool that provided pupils with a set of virtual manipulatives. The 37 pupils involved in the study were 8–12 years old and from two special-education schools in the Netherlands. Comparison of the performance scores in the two formats showed that an ICT-based assessment format, including a dynamic visual tool, can reveal weak pupils' learning potential and strategy use. The study also pointed out that 'partial-tool use', ie, not carrying out the complete subtraction operation with the tool, can provide sufficient support to find the correct answer.

The outcomes, processes, and challenges of inclusive education in Victoria

A collaborative school culture is important to improve the learning of students with special education needs. This could be met through a consolidation of a school's understanding of students' learning difficulties as environmental causes and an increase of teachers' confidence and knowledge on addressing students' diverse needs.

Student researchers in the middle : using visual images to make sense of inclusive education

Using ‘visual narrative’ theoretically and practically, this paper explores issues of inclusive education, during a period of curriculum reform and renewal in Australia. In Australia, the middle years of schooling, Years 5 to 9, are well researched and known as a period when students disengage with learning and participation in schooling. Research in the middle years affirms the importance of engaging with ‘student voice’. In this special edition, we are aiming to highlight how the use of visual imagery can be a rich source of understanding, illustrating students’ self-knowledge of schooling. Methodologically we refer to our research approach as ‘visual narrative’. Other writers in this edition use the term ‘photo voice’. For researchers it is important to highlight the differing orientations that ‘visual narrative’ and ‘photo voice’ signify. The terms are not mutually exclusive but highlight differing research possibilities and emphasis. Our argument, through the use of visual narrative produced by middle years’ students, is that visual texts open out some innovative possibilities for understanding inclusive education and supporting new relationships with our research community. Such approaches are not new; however, in a field such as special education that purports to support marginalised groups, liberatory research methods are under-represented. This paper aims to open out these discussions and provide a way forwards for teachers and researchers interested in breaking apart why it is that inclusive education remains a never-ending struggle.

The dissection of paraprofessional support in inclusive education: ‘you're in mainstream with a chaperone’

The experiences of young people with disabilities of inclusive schooling are largely underresearched. This paper reports recent findings of a small-scale Australian qualitative study, in which secondary students with vision impairment spoke about their experiences of receiving paraprofessional support. Two overarching themes emerged from this study: ‘light’ and ‘heavy’ paraprofessional support. The results presented here demonstrate that participants described that support personnel upheld the strong arm of the special education tradition, which was manifestly detrimental to their inclusion. Raw data is presented to elucidate the emergent themes, and to explain the various pedagogical and general support roles of class and special educators in eliminating the need for direct paraprofessional presence in lessons. The light and heavy model of support is also examined in terms of how it fits into the complexity of the education discourse and the young people’s own aspirations for full inclusion.

Using online video-recorded interviews to connect the theory and practice of inclusive education in a course for student teachers

This article reports on a study into university preservice teachers’ perceptions of online video-recorded interviews as an alternative to the traditional lecture format in a course on inclusive education. With the aim of assisting preservice teachers to link theory and practice, the series of video-recorded interviews focused on key concepts around educating students with diverse needs and abilities. The interviews were conducted between the course coordinator and a number of professionals with relevant field experience in special education and inclusion, and were then made available to preservice teachers online. Survey data indicated that this type of delivery model was perceived as effective in promoting engagement and learning, and in facilitating an understanding of the connection between theory and practice. Implications for teacher education are discussed.