Medical Review Evaluation Process
If you are a new school nurse, make sure you read the information on the ISBE Rule 226.160 regarding licensure required for the steps in the special education process. It is a bit confusing, so please consult your administrator before attending your first special education meeting.
Special education instruction and related services are available for children with special needs from birth to age 21. Special needs may be in the areas of vision, hearing, health, and behavior; or involve skills in fine or gross motor, speech/language, cognitive or learning, social and emotional, and adaptive or self help. To be eligible to receive special education services, the child must have a disability that impacts educational performance.
A referral, or request for evaluation, in the context of special education services is a process asking the school district to evaluate a student to see if the child qualifies to receive special education services. A referral can be made by the school district (through a teacher or other school personnel involved in the student’s education) or by a parent or guardian in writing. A referral may also be made by an employee of a State educational agency, another State agency, a local school district, or a community service agency. A referral is a required first step before an evaluation can take place.
Within 14 days of receiving the written request for an evaluation from a parent or outside agency, the district will decide whether to evaluate the child or not. If the district determines that the evaluation is not necessary, it must notify the parent in writing of the decision not to evaluate and the reasons for the decision. If the district determines that an evaluation is warranted, then the district must provide the paperwork to provide formal written consent.
This is usually the first step in the special education process. Typically a meeting is scheduled with the child’s parents and the members of the school team to discuss the referral and obtain formal written consent. The team reviews the following domains and reports what is currently known about the student to determine what further information would be needed for the child’s evaluation. Input in each of the domain areas are received from the parents and the educational team.
The eight domains are:
- Academic Achievement – reading skills, writing skills, listening comprehension, oral expression, math reasoning and math calculation. The teacher usually reports on how the student is performing in school.
- Functional performance – non-academic school behavior (i.e. dressing, eating organization, time on task, self care, etc.)
- Cognitive functioning – concerns about the student’s intellectual potential
- Communication Status – language development and intelligibility, and ability to express and understand language.
- Health Status – the child’s overall health status and any health conditions that may impact the child’s ability to function in school. Included in the assessment should be the prenatal, birth, and developmental history of the child.
- Hearing and Vision status – evaluates the student’s current hearing and vision status and history.
- Motor Abilities – concerns regarding the child’s fine or gross motor skills (hand writing, cutting, jumping, running, ability to safely navigate the school environment, etc.).
- Social and emotional status – environmental stressors, social/emotional skills, behavior, adaptive behavior in school, and family social history.
At the meeting, each domain is reviewed and existing information is documented. The decision about whether additional information is needed is documented, in addition to the person who will be responsible for gathering that information or performing the necessary testing. For example, if speech is a concern, then a speech evaluation would be completed by the speech pathologist. If health is a concern, a health history will be completed by the nurse. Hearing and vision screenings are a required portion of the evaluation, but a health history may not be requested if there are no health concerns.
The school district legally has to complete the evaluation process, determine if the child is eligible for services, and write the IEP within 60 school days of obtaining the written consent for the evaluation.
The eligibility meeting is held after the school staff has completed the evaluations that were identified as necessary in the domain meeting. IDEA lists different disability categories under which children may be eligible for services. For a child to be eligible for services, the disability must affect the child’s educational performance.
Students may qualify for services under one or more of the following categories:
- Cognitive disability
- Developmental Delay
- Emotional Disability
- Hearing Impairment
- Multiple disabilities
- Orthopedic impairment
- Other health impaired – see description below
- Specific learning disability
- Speech or language impairment
- Traumatic brain injury
- Visual impairment
IEP (Individual Education Plan) Meeting –
The IEP meeting is typically held immediately after the Eligibility meeting and looks like a seamless process. Goals are written for each area in which the child qualifies for special education services (i.e. if a child qualifies for speech services, speech goals are written). The goals are written for a one year time period. After all of the goals are presented to the team, the team determines how to best provide the services addressed in the plan. The services must be provided in the least restrictive environment. The least restrictive environment means that, to the maximum extent appropriate, students with disabilities are educated with students who are not disabled. The team must determine the least restrictive environment for each student based on his or her individual needs.
Students with disabilities are required by law to have an educational program that is reviewed each year. A review involves an updating of the student’s progress and planning his/her educational program, and development of a new IEP for the upcoming year.
Three Year Re-evaluation
An assessment that occurs every three years or more often if needed, to determine continued eligibility for special education services.
How to Prepare for Special Education Meetings:
The following information is a guide to how to prepare for special education meetings. Keep in mind that districts may do things differently than outlined here and that you should check with your administration before proceeding with meeting preparation.
Domain meeting :
Review the student’s health file. Take note of any health conditions that may affect the child’s ability to function at school. Bring a list of medications that the student is currently taking. Bring results of hearing and vision screening or vision exam if available.
Try to get in the classroom to observe the student. Talking to the teacher will also give you an indication if there are any health problems that may be affecting the student’s performance in school.
If a health history was requested at the domain meeting, you will be required to present the history summary at the meeting.
If the hearing and vision screening were not completed at the domain meeting, these results must also be presented.
If the student requires nursing services in school, a nurse who holds a Professional Educator License in Illinois must write goals and present them at the IEP meeting.
Annual Review Meeting:
Review last year’s IEP for health information. Compare with current health information and be prepared to report any updates or changes as necessary. Bring a list of medications that the student is currently taking.
Bring this year’s hearing and vision screening results and vision exam results if available.
3 Year Re-evaluation Meeting:
Review the health portion of the original IEP. If a full health history was completed, compare it with the student’s current health information to determine if a health history update is needed.
Bring this year’s hearing and vision screening results and vision exam results if available.
Completing a Health History:
Your district should have a format to follow when completing a health history. Here is the information that my district includes in the health history:
- Demographic information – name, date of birth, parents’ names.
- Physicians’ names and dates of last visits.
- Dental history
- Prenatal history
- Developmental history
- Past Medical history
- Current health (review of systems)
- Family history
Other helpful information:
Early Intervention Services – programs and services provided to infants and toddlers with disabilities from birth through age 3. These services are not provided by the school district, but are available in the community.
Early Childhood Services – programs and service provided to children with disabilities from age 3 through 5. School districts are responsible for providing these services to children.
ADA – Americans with Disabilities Act – Enacted in 1990, this act gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities to public accommodations, employment, transportation, state and local government services, and telecommunications.
IDEA – Individuals with Disabilities Education Improvement Act of 2004 – The federal law mandating that all children with disabilities have available to them a free, appropriate, public education that emphasizes special education and related services designed to meet their unique needs and prepare them for employment and independent living.
IEP – Once it is determined that a student meets the criteria to receive special education and related services, an Individualized Education Program (IEP) will be developed. An IEP is a written statement of the educational program designed to meet the student’s needs and is developed by a team. The IEP includes a detailed description of what will be done to give the student the extra help needed. The IEP will change based on the student’s needs – it is like a road map showing where the student is and where he or she is going.
Other Health Impaired– This is one of the disability categories identified in the Eligibility section above. Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment that:
- Is due to chronic or acute health problems such as asthma, ADD or ADHD, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome
- Adversely affects a child’s educational performance
Medical Diagnosis: There is no explicit requirement in the IDEA or the Part B regulations to include a medical diagnosis as part of the eligibility determination for any of the disability categories. http://www2.ed.gov/policy/speced/guid/idea/iep-qa-2010.pdf
The school does not need a diagnosis from a physician to determine that a child is eligible for special education services. Likewise, a physician cannot write an order for special education services. The school team is responsible for determining if a child qualifies for special education services.