8 Related Services


Forms/Links

Chapter Revision date: 08/2018

For information about related services in general, refer to section 8.1 

For information about specific related services/departments (in alphabetical order), refer to section 8.2  

Related services are additional special education services that a student may require in order to make progress in his or her Individualized Education Program. 

An “area of need” identified on an IEP does not automatically indicate that related services are required.  Related services are required when a student needs additional support in order to make progress towards annual IEP goals.  Related service providers may have detailed knowledge concerning areas of need that require assessment or support and should be consulted prior to developing an assessment plan. 

Notes  Assessment for a related service may not be added to an assessment plan without consultation from a representative for that related service. 

Related Services may include, but are not limited to, the following services:

Adapted Physical Education

Assistive Technology

Audiology

Counseling and Guidance

Specialized (D/HH) Deaf and Hard of Hearing services

    • D/HH Interpreter Services

    • D/HH Transcription / Note taking

    • D/HH Speech / Communication Skills

Health and Nursing

Music Therapy

Mental Health Related Services (MHRS)

Occupational Therapy

Specialized (PHI) Physical Health Impairment

Physical Therapy

Specialized Physical Health Care

Speech-Language Pathology

Transition Services

Specialized (VI) Vision Impairment Services

    • VI – Orientation and Mobility

    • VI – Braille Transcription

    • Vision Therapy 

8.0   Related Services on the IEP 

In the IEP process, Related Services should not be thought of as an area of need.  Instead, Related Services may support an area of need.  For example, a student does not have “OT needs” but has fine motor needs that affect educational progress and may require the support of an occupational therapist or the educational specialist.

Notes The discussion of related services is held after student strengths and areas of need are identified, after goals are developed, and after necessary accommodations or modifications are identified.

 8.0.1               Related Services - Present Levels

With the exception of Health, all sections of the Present Levels of Educational Performance may include input from multiple IEP team members; there is no area of the Present Levels that is the sole responsibility of a specific related service provider.  For example, the Speech Pathologist, classroom teacher and Education Specialist may all have input regarding the student’s communication skills in the school environment.  APE, PT and OT specialists may have detailed knowledge about a student’s motor ability, but a student’s teacher or Educational Specialist may also provide input on how a student is navigating the school environment or how the student is using classroom tools. 

8.0.2               Related Services - IEP Goals

If the IEP team determines that related services are required for the student to make educational progress, the related service provider must be connected to a goal or goals that support student achievement in the classroom setting.  Any staff/service providers responsible for implementing the goal need to be indicated in the “persons responsible” section of the goals.

8.0.3               Service Delivery Model 

One-on-one or small group pullout intervention is not the only “direct” intervention service.  The continuum of servicesranges from the least restrictive service of collaborating with staff to the most restrictive service of removing student from their educational setting to provide service. 

The student’s needs are best met when skill acquisition is connected to meaningful school activities, with classmates, and in natural settings where teachers, support staff, and service providers work together and model effective strategies. 

8.0.4               Special Factors

Below are examples of language that may be used on the Special Factors page 1 of the IEP: 

“List Subject Area” - WHAT is the content area(s) that require support?

Example:

Written language, reading comprehension, speaking & listening, social interaction, self-help, physical education

 “Service” – WHICH service will be supporting these areas?  (SLP, OT, PT, APE, etc.)

 “Environment” - WHERE will this service be provided the majority of the time? 

  • Services provided within a special education classroom need to be listed as Separate Classroom.

  • In some cases it may be appropriate to list a service twice with 2 different    environments when the content area being supported is different.

  • Example: 

Speaking & Listening

Speech development

Language & Speech

Separate Classroom

Speaking & Listening

Language development

Language & Speech

General Education

“Comments” – HOW will the service be provided?

Do NOT include specific hours or minutes per week since students benefit from some flexibility in how services are to be provided.  It may be appropriate to indicate how frequently a service will be implemented (twice weekly, weekly, every other week)

Example:

Services will typically be provided on an every other week basis for up to 8 hours per year.   (This allows for some student absences, special activities, statewide testing, etc). 

Indicate how a specific area of need could be addressed through directinteraction with the provider.

Examples:

Skill building with [service provider] present will focus on...

Co-teach with teaching staff.

Small group instruction. 

For collaboration services, indicate who the service provider will collaborate with and for what purpose.

Examples:

The PT will collaborate with APE, MT, SLP and teacher to increase movement opportunities in all settings. 

The SLP will collaborate with teaching staff to develop and implement classroom language lessons. 

For consultation services indicate who is the intended focus of the consultation and for what skill or area of need.  Consultation is with another adult, and the child may not be present.

Example:

The [service provider] will consult with “whom” for “what”... 

Notes If the parent remains concerned about knowing the "weekly minutes," it is appropriate to write in Special Factors Page 2, section C:

Example:

Service time for PT is approximately XX minutes every other week. Amount of time per session may depend on the intervention focus at that time. 

  • All Related Services Providers document IEP services provided to students in MediCal billing program.   Parents, Principals and other school officials may request MediCal billing program documentation to verify services provided.  Parents wanting access to this information should make their request directly to the case manager. 

8.0.5               Implementing and Monitoring Related Services

Notes For students with the Federal Handicapping Condition of “Speech Language Impairment” who do not require Specialized Academic Instruction, the Speech Language Pathologist will be the service provider and the case manager (“speech only”).  SLP will be the primary service. 

In the majority of situations, the case manager is the teacher providing specialized academic instruction.  Case manager responsibilities with respect to related services include: 

  • Ensure that each general education teacher and related service providers have been given information regarding his or her specific responsibilities in implementing the student’s IEP.  This includes the specific accommodations, modifications and supports that must be provided to the student in accordance with the IEP.

  • Ensure that related services are available and scheduled.

  • Completion of the Service Provider Log.  Refer to Forms/Links. 

Progress Reports:

Related service providers are required to provide progress reports to parents as indicated on each student’s IEP.  Progress reports must be entered into the district’s electronic IEP system.  A copy of the progress report must be given to the parent/guardian and must be included in the student’s special education container within the cum file. 

8.1             Adapted Physical Education  

Forms/Links

 What is Adapted Physical Education?  

Adapted Physical Education (APE) is a diversified program of developmental activities that are modified to meet the district’s physical education standards. A carefully designed physical education program is developed and implemented within the psychomotor domain for individuals with disabilities. Assistance can be provided to students in the general education program and/or along a continuum of physical education services. The Adapted Physical Education teacher must have a credential authorizing the teaching of APE, as established by the Commission on Teacher Credentialing. Our students range from preschool to high school. You may also hear Adapted Physical Education referred to as Adapted PE or APE.

What is General Physical Education?

Physical Education in the San Diego Unified School District plays an integral role in providing a balanced education for the whole child. Physical education makes a unique contribution to the total educational process by addressing the knowledge (cognitive), social (affective), as well as physical (psychomotor) development and skills of each child.

According to the National Association of Sport and Physical Education, “The goal of physical education is to develop physically educated individuals who have the knowledge, skills and confidence to enjoy a lifetime of physical activity.”

Least Restrictive Environment

All children, unless excused or exempted are required to have an appropriate physical education requirement. In addition, these services should be provided in such a manner that promotes maximum interaction between children with disabilities and their non-disabled peers as provided in the United States code.

Continuum of Physical Education Services

Functions of General Education:

General Physical Education: Full spectrum of game, sport and fitness activities

Modified Physical Education: Participation within general physical education, with appropriate modifications or adjustment 

Specially designed Physical Education:  Physical education programming for a special education class, with minimal or limited adaptions needed.

Functions of Adapted Physical Education:

Adapted Physical Education: Direct physical education services for eligible students who have been precluded from other services delivery options.

Adapted Physical Education Collaboration: Physical education services provided and/or implemented jointly with parents and other staff.

Adapted Physical Education Consultation: Ideas and suggestions for individualizing physical education instructional strategies, equipment, and curriculum. 

State Mandated Minutes for Physical Education 

Grades 1-6:

            200 minutes every 10 school days

Grades 7-12:

            400 minutes every 10 school days 

Adapted Physical Education Initial Referral Process 

Adaptations, accommodations and modifications within the existing general physical education program shall be documented before a child is referred to adapted physical education. 

If a student who is eligible for special education under IDEA, is enrolled in general or specially designed physical education, and is not successful in the class, the following options exist:  

The site team may hold a meeting to determine appropriate adaptations, accommodations, or modifications to attempt within the current physical education setting. 

The classroom teacher or the physical education teacher, may independently, identify and implement various interventions in either a general or specially designed physical education setting. 

The teacher or the site team may consult the adapted physical education teacher for suggested adaptations, accommodations or modifications that can be attempted. 

After reasonable interventions have been attempted and documented, the site team may make a determination that a referral for adapted physical education assessment is appropriate in order to determine the individual’s needs. 

Contact your site Adapted Physical Education teacher to initiate the process 

What is Action Based Learning? 

In San Diego Unified, we have a Four Pronged Approach to Action Based Learning.  We work in collaboration with district departments and community partners to increase movement in and out of the classroom in a variety of ways.  The Four Pronged Approach includes:

Action Based Learning Labs

Quality Physical Education

The IMPACT program

Movement in the Classroom

We have developed and implemented Action Based Learning Labs throughout the district serving hundreds of students from the Infant Program to High School.  Each motor lab is designed to meet the needs and levels of all learners. Stations are developed within the motor labs to provide developmentally appropriate movement opportunities and physical activity, combined with academic content, to create an environment for optimal brain function.

Ed Code requires Physical Education 200 minutes every 10 days for elementary students and 400 every 10 days for secondary students. This is provided by a Physical Education teacher or classroom teacher. We have developed resources for teachers, which includes teacher trainings, curriculum maps & assessment resources to assist in quality Physical Education at ALL schools.

We have partnered with the UCSD Department of Pediatrics to implement the IMPACT (Increased Movement and Physical Activity Class Time) Program. The IMPACT program is a designed to reinstate physical activity in schools without a Physical Education teacher. Athletes from UCSD participate in leading the students through an outdoor circuit of stations focused on physical fitness and motor skills. 

Brain research indicates that the human body needs to move every 17-20 minutes to remain alert. Resources have been developed to provide movement opportunities that are fun, quick and easy to implement in a classroom and require little or no equipment. These movement opportunities release chemicals in the brain that aide in focus and attention to facilitate learning.  Exercise grows brains cells!

Contact Information

 
Program Manager
(858) 573 – 5941
 
Becky Paradise
Adapted Physical Education Lead
(858) 573 – 5973
 
Katrina McClanahan
Adapted Physical Education Lead
(858) 573 – 5974

Location

Wiggin Center
Adapted Physical Education
4350 Mt. Everest Blvd., Room B-13
San Diego, CA 92117

 

8.2             Assistive Technology 

Forms/Links 

Definition 

Federal and state laws require IEP teams to consider the need for assistive technology devices and services under the Special Factors section of the IEP for all students in special education. 

The terms "assistive technology device" and "assistive technology service" are defined as follows in the IDEA: 

assistive technology device means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability. The term does not include a medical device that is surgically implanted, or the replacement of such device. 

assistive technology service means any service that directly assists a child with a related ability in the selection, acquisition, or use of an assistive technology device.  The term includes:

  • The evaluation of the needs of a child with a disability, including a functional evaluation of the child in the child's customary environment;
  • Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by children with disabilities;
  • Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
  • Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;
  • Training or technical assistance for a child with a disability or, if appropriate, that child's family; and
  • Training or technical assistance for professionals (including individuals providing education or rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of that child.

 8.2.1            When to Refer a Student 

A team approach is taken in recommending and acquiring assistive technology devices and services as well as in enabling students to use such devices and services. The student’s team always includes his or her teacher and one or more individuals designated by the district who are qualified to assess the student in the area of assistive technology.  Assistive Technology Department Team personnel are available to all educational and support staff to provide technical assistance, consultation, problem-solving and resource information.

A referral should be made to the Assistive Technology Department when current assistive technology is no longer working or when the team needs more information or resources to meet the educational needs of the student. See Consideration of Assistive Technology:  A Guide for IEP Teams, a form available from the AT Department. Refer to

Forms/Links.

 Notes Case managers of students who are enrolled in low incidence programs as their primary placement should contact the Low Incidence program resource teachers prior to making a referral for assistive technology services. 

 8.2.2         Referral Process 

A request for consultation or assessment for assistive technology devices and/or services may be made for a student in general education as part of a referral for special education.  However, it is recommended that the IEP team convene to discuss the results of the comprehensive assessment and then consider the need, if any, for assistive technology. 

  1. Generally, requests from a student’s assessment/student study team for assistive technology are to be made via the Request for Assistive Technology Services form, which may be obtained from the Assistive Technology Department.  In addition, the Consideration of Assistive Technology:  A Guide for IEP Teams form should also be completed.  Requests can be made for a consultation, evaluation, or follow-up to a previous referral by checking the appropriate box on the form.  A description of the specific educational need for which AT assistance is being requested must be included with the request.  Refer to Forms/Links. 
  2. A copy of the current IEP and any current assessment reports should be attached to the request. 

Additionally, the law also states that “on a case-by-case basis, the use of school-purchased assistive technology devices in a child’s home or in other settings is required if the child’s IEP team determines that he child needs access to those devices in order to receive FAPE.” [34 CFR 300.308 (b)]  To include Assistive Technology Services as a related service, an assessment must be “conducted by persons competent to perform the assessment” and a report prepared and presented to the parents at an IEP Team meeting.  The type of service, duration and amount of time must also be specified on the IEP. 

  1. If determined to be required, assistive technology devices and services may then be included as part of the IEP:
  • within a specific program;
  • as supplementary aids and services; and/or
  • as a related service. 
  1. If/when the IEP team has determined that a child with a disability requires a particular assistive technology device or services, a statement regarding assistive technology services needs to be included in the IEP.  This may include a statement in the present levels, special factors section, meeting notes, or by use of technology within the goals and objectives.  Convene an IEP team meeting or amend the current IEP to add AT services or devices. 

Notes In the case of students with low incidence disabilities, the need for specialized services, material or equipment is determined through an assessment conducted by appropriately credentialed personnel. When a student’s IEP team determines that such services, material and/or equipment are required to meet the student’s unique educational needs, they are provided by the special education program/department serving the student. 

Service Requests  

Requests for Assistive Technology Services should be made after reviewing the information found on the Assistive Technology Moodle (Forms/Links) and then downloading the appropriate form to be submitted. 

Contact Information:

(858) 573-5969

Location:

Assistive Technology
Wiggin Center, B-10 

8.3                Health and Nursing Services

Definition 

Credentialed School nurses provide health services to all special education students who require nursing intervention and/or consultation.  It is the role of the credentialed school nurse to strengthen and facilitate the educational process by improving and protecting the health-related barriers to learning in individual children. Credentialed school nurses respond to health related needs of special education students in many ways.  Nursing services may include reviewing the student’s health records/histories, participating in pre-assessment meetings, assessing for and writing of Nurse Assessment Reports (initial and triennial assessments), participating in the IEP process, as well as, performing needed specialized health care procedures. 

8.3.1         When to Refer a Student 

Refer a student to the credentialed school nurse whenever a student’s medical diagnosis indicates professional nursing judgment, consultation and/or intervention.  Students who are newly diagnosed, new to the district or have a medical condition that is unstable should also be referred. 

8.3.2         Referral Process

Contact the site nurse, cluster coordinator and/or case manager who will confer with the Nursing & Wellness office when indicated.
 

8.3.3          Addional Information

Special Education Policy for Diapering and Toileting Students (refer to Forms/Links for more info.)

Annual special education training for toileting/diapering skill trainings have been implemented to ensure that special education staff who provide diapering and toileting as part of the instructional program for children with special education needs are being followed.  SDUSD District requires all employees to complete mandatory on-line trainings, monthly safety professional development trainings throughout the school year. These practices ensure safety to special education staff performing and students requiring this service.

 

Contact Information: 

Michelle Bell, Program Manager

619-725-5501 

Location: 

Nursing and Wellness

Eugene Brucker Education Center

Room 2228  

8.4         Music Therapy 

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Forms/Link 

Definition 

Music therapy is the clinical and evidence-based use of music-cued interventions to accomplish individualized goals.  As indicated in the California Code of Regulations, music therapy can be provided as a related service for students who require it in order to benefit from their educational program.  The purpose of music therapy services in the special education setting is to help facilitate functional educational outcomes in IEP goal areas such as academic learning, communication, social skills, motor development, behavior, and daily living skills.  The music therapist also assists with the fading of musical cues and generalization of skills to the non-music setting. 

Music therapy is provided by personnel who hold a Music Therapist – Board Certified credential from the Certification Board for Music Therapists (CBMT) on the completion of all academic and clinical training requirements, and after successfully passing the CBMT National Board Certification Examination.  Music therapy as a related service does not include provision of music education or sound therapy programs. 

8.4.1               When to Refer a Student 

A music therapy evaluation may be considered by the IEP team for students who require additional support to make adequate progress on IEP goals and have shown indicators that music is a viable learning avenue. 

Prior to making a referral, the case manager should review the “Music Therapy as a Related Service: Sample Indicators” page in the Music Therapy Packet available on the SDUSD website.  Refer to Forms/Links. 

Based on research, music therapy interventions can most functionally support areas such as: 

  • Learning and memorization of language concepts, pre-academic or basic academic facts (such as letter/number ID, money concepts, counting, categories, colors, sight words, spelling name, letter sounds, prepositions, synonyms, addition/ multiplication facts, time telling, calendar concepts)
  • Basic communication/social skills (such as turn-taking, greetings, conversation, social initiation, increasing length of utterance, describing, vocal imitation, labeling objects , action words, increasing length of utterance, requesting, yes/no questions, “Wh” questions, initiating use of a switch, articulation)
  • Behavioral/emotional/sensory needs (such as classroom rules, identifying appropriate vs. inappropriate behavior, attending behavior, self-regulation, relaxation/ anger management techniques, identifying emotions)
  • Daily living skills (such as personal information, community safety rules, memorizing daily schedule, steps to hand washing, toileting, tooth brushing)
  • Rudimentary motor skills (such as reaching/grasping for an object, motor imitation skills, left/right, cause/effect) 

Music cueing is less effective for students whose main hindrance to learning is overall comprehension or generalization of skills, or for students whose goals are at a level that is significantly more advanced than the sample skills listed above. 

8.4.2               Referral Procedures 

  1. All requests for Music Therapy assessment must be in writing using the "Music Therapy as a Related Service Packet" available on the SDUSD website. Refer to Forms/Links. 
  2. After reviewing the Sample Indicators and Overview forms in the packet, if a request for a music therapy evaluation is warranted, the case manager completes the 2-page Music Therapy Checklist in the packet and sends to the Music Therapy Clerk via district mail at mtclerk@sandi.net . The music therapist will be in contact with the case manager once the checklist is received.

 Notes An evaluation plan should not be generated for music therapy until the music therapist has reviewed the Music Therapy Checklist and conferred with the case manager. 

Contact: 

Music Therapy Clerk:  mtclerk@sandi.net 

Location: 

Wiggin B-8

 

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8.5             Occupational Therapy (OT)  

Definition 

Occupational Therapy is a related service designed to improve functional skills needed for participation in academic, school and activities of daily living tasks for students with special needs.  Therapy may be provided to support a student's educational goals by facilitating improved performance and providing adaptations in the areas of motor foundations, visual motor/perceptual skills, self-help and emotional regulation. 

8.5.1               When to Refer a Student 

Students may require OT services if they demonstrate difficulties in the following areas, and when the expertise of the OT is required for problem-solving and/ or new skill building: 

  • Poor hand use (fine motor mechanics) that affects school tool use, manipulation of clothing fasteners or food containers, and other fine motor manipulation tasks needed in the school setting.

  • Difficulties in postural control that affect the student's ability to remain seated, or sustain school and play activities.

  • Difficulty with visual perception and/or visual motor skills affecting reading and writing, such as copying from the board, loss of place while reading or poor spacing and formation of letters during handwriting.

  • Difficulty with self-help skills, such as mealtime participation, clothing management or hygiene within the educational setting.

  • Poor organization and/or sequencing of tasks that cannot be sufficiently addressed by common organizational strategies such as using a calendar, task completion list and organizing a student’s binder per subject.

  • Difficulty in learning a new motor task that is required by the student’s school routine.

  • Significant over-reaction, under-reaction, or seeking of touch, movement or other sensory input, that impacts social participation, emotional regulation, attention and/or learning. 

8.5.2               Referral Process 

All requests for OT assessment or consultation must be communicated to the OT Specialist assigned to the school site. The site OT specialist may request the referring person to use the Request for OT and/or PT Services form.  When the OT Specialist assignment is unknown, the request is put into writing using the Request for OT and/or PT Services form.  Forms are submitted directly to the OT & PT Services office (Wiggin Center, B-11).  All sections of the request form need to be completed thoroughly, and the required documentation must be attached to the request form.  Refer to Forms/Links. 

Teachers may also contact the Senior OT Specialist to determine which OT is assigned to the site.  Contact information is below. 

Contact Information: 

Andrew Gilbert, OTR/L

agilbert@sandi.net 

Location:

Wiggin Center B-11 

 8.6              Physical Therapy (PT)

 Forms/Links

 Definition

Physical Therapy is a related service designed to support students with physical disabilities, particularly those with disorders of posture and movement, to access the school environment and curricula.  Therapy may be provided to support a student's educational goals by facilitating improved performance and providing adaptations in the areas of gross motor development and coordination, functional mobility, balance and instructional seating and positioning. 

8.6.1               When to Refer a Student 

Students may require PT services if they demonstrate difficulties in the following areas, and when the expertise of the PT is required for problem-solving and/ or new skill building: 

  • Difficulty with functional mobility skills (walking, stair climbing, avoiding obstacles, etc.) within the classroom and on campus.

  • Balance difficulties that may affect safety or participation in school activities.

  • Decreased muscular strength or flexibility that may limit performance in school activities.

  • Difficulties with movement coordination or performance of basic gross motor skills required in the school setting.

  • Difficulties with functional, upright seating and positioning for instructional activities.

  • Posture and movement dysfunction related to neurological defects or syndromes.

  • Severe physical or orthopedic disabilities that require ongoing consultations. 

8.6.2               Referral Process 

All requests for PT assessment or consultation must be communicated to the PT Specialist assigned to the school site. The site PT Specialist may request the referring person to use "Request for OT and/or PT Services" form.  When the PT Specialist assignment is unknown, the request is put into writing using the "Request for OT and/or PT Services" form.  Forms are submitted directly to the OT & PT Services office (Wiggin Center, B-11).  All sections of the request form need to be completed thoroughly, and the required documentation attached to the request form.  Refer to Forms/Links. 

Teachers may also contact the Senior PT Specialist to determine which PT is assigned to the site.  Contact information is below. 

Contact Information: 

Shara Olivier, LPT

solivier@sandi.net

(858) 627-7466 

Location:

Wiggin Center, B-11 

8.7            Specialized Physical Health Care Services (SPHCS)

 

Definition

SPHCS are nursing services required during the regular school day, which enable students with special needs to attend an appropriate educational program.  These special procedures must be requested by the parent/guardian and prescribed by a licensed physician.  SPHCS performed in the school setting may include, but are not limited to such procedures as, catherizations, gastronomy feedings, ostomy care and blood glucose testing.

 

Notes No school staff may assist student with SPHCS until all forms, equipment and training are in place.

8.7.1             When to Refer a Student

Refer a student immediately upon awareness of need.

8.7.2             Referral Process

Upon parent/guardian notification of student’s need for specialized physical health care services, contact the site nurse who will confer with the Nursing and Wellness office.

Contact Information:

Site nurse   

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8.8            Speech and Language Services  

Forms/Links  

Definition 

A student between the ages of 0-21 years of age shall be eligible for speech and language services when he or she demonstrates difficulty understanding or using spoken language to such an extent that it adversely affects his or her educational performance and cannot be corrected without special education and related  services.  Speech and language disabilities can result from impairments in articulation, voice, fluency, and/or language skills that occur in the student’s primary language.  

8.8.1             When to Refer a Student 

 A student may be referred for a speech and language assessment when there is a suspicion of a disability in speech/language that affects school progress.  This is generally after it has been determined that appropriate general education resources have been implemented and adequately documented, and that the student’s speech and language needs cannot be met with these modifications within the regular instructional program.  There may be times when the student’s speech/language needs are clearly evident, and depending upon the circumstances, an immediate referral may be made. 

8.8.2       Referral Process  

A formal referral for a speech-language assessment specifically seeks to identify whether the student requires speech-language services.  Notes from teachers suggesting that a speech-language pathologist look at an individual student do not constitute a referral.  Such informal requests seek broad information and are designed to obtain suggestions for regular program modification(s).  

A referral must contain a brief description of the attempted modifications to the student’s regular education program and provide adequate documentation of the results of the modifications.  This description is often provided by identifying attempted modifications of the regular education program and the level of success of each modification over a period of time. 

The referral may be made directly to the Speech-Language Pathologist, case manager, school psychologist, administrator. 

Contact:

Speech-Language Pathology Program

(858) 573-5941 - Phone
(858) 573-5981 - Fax

Location:

Wiggin Center B4

4350 Mt. Everest Blvd

San Diego, CA 92117

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 8.9            Vision Therapy 

Forms/Links 

Definition 

Vision Therapy (VT) is a related service, an additional special education service that a student may require in order to make progress in his or her Individualized Education Program.  VT is designed to support a student’s ability to participate in the educational setting where evidence supports that vision skill ability is affecting the student’s performance of academic tasks.  For example, Vision Therapy can support a student’s ability to keep his/her place in the text if the student demonstrates decreased eye movement control.  Vision Therapy supports improving a student’s vision skills through visual activities performed by a Vision Therapist.  A Vision Therapist must be supervised by an Optometrist or Ophthalmologist with specific training in Developmental Optometry. 

Vision Therapy does not support chronic vision issues such as decreased visual acuity (which requires glasses or prescription lenses) or reduced vision or blindness. Students with reduced vision or blindness are best supported by specialized Visually Impaired (VI) services.  

8.9.1       When to Refer a Student  

If a student has difficulty performing vision related academic tasks (such as reading, writing and/or math) and that student does not have a chronic or degenerative eye condition, the IEP team needs to collaborate to determine if the student might require additional support from Vision Therapy to improve academically related vision skills.  Teaching staff members are best able to describe behaviors indicative of a vision problem affecting academic performance.  The IEP team needs to include the site nurse to ensure that the student's vision acuity has been addressed and the student has the appropriate prescription lens for acuity issues.  The school psychologist can provide the IEP team with previous testing on Visual Motor and Visual Perceptual Skills.  The IEP team needs to include the occupational therapist in the discussion to determine if the student has a visual motor or visual perceptual issue that could effectively be supported by Occupational Therapy as a related service.  

8.9.2       Referral Process 

A referral for possible vision therapy services may be made after following the procedures and completing the required forms as found on the SDUSD website.  Refer to Forms/Links  

The following staff responsibilities are outlined below: 

  1. Case Manager’s Responsibilities: 

    The Case Manager is responsible for completing all steps of the request process with appropriate IEP team members. The case manager guides the IEP team to consider:

    •    possible medically related vision conditions that require referral to the family’s eye care provider;

    •    possible supports to help students in the classroom, including accommodations and/or modifications; and

    •    the educational relevance of Vision Therapy as a related service. 

    The Case Manager will follow procedures, complete required forms, and submit the request packet to the Vision Therapy office. 

  2. IEP Team Responsibilities: 

    All members of the IEP team are responsible for understanding that Vision Therapy is a related service that provides meaningful educational benefit to the student. The IEP team needs to review the “Checklist of Visual Behaviors” and evaluate if a student is having learning difficulties unrelated to vision skills, such as decreased understanding of written material, or decreased attention to all academic tasks, or if a student’s struggles are primarily related to difficulties with vision skills.  Refer to Forms/Links. 

    The IEP team identifies student IEP goals that Vision Therapy could support.  Possible educationally relevant goals/needs related to vision could be determined from the Checklist of Visual Behaviors items that were rated as occurring “always” or “frequently” and appear to affect the student’s ability to access the curriculum.  If the IEP team finds no areas of educational need that vision therapy could support, a developmental vision assessment would not be required and vision therapy would not be considered to be a necessary related service.  In this instance, a Prior Written Notice must be sent to the parent/guardian, informing them it was determined that a developmental vision assessment is not required. 

  3. School Nurse’s Responsibilities: 

    When vision is considered to be an area of concern, the school nurse needs to perform a vision screening to make sure that the student does not have a medically related vision need that would require the attention of the family’s eye-care provider. (For example, a student may have decreased vision acuity causing blurred vision resulting in difficulty with reading and writing tasks. In this instance, the only intervention the student may need would be prescription lenses.) The school nurse would perform a vision screening for acuity as well as a “muscle balance” screening to look at the student’s eye muscle control.  Medically related vision symptoms are listed on the shaded items (#1 to #13) on the Checklist of Visual Behaviors. 

Occupational Therapist’s Responsibilities: 

When vision is considered to be an area of concern, the school occupational therapist reviews the case to determine if the visual challenge could be supported by occupational therapy.  Occupational therapists can support students who demonstrate challenges with visual perceptual skills or visual motor skills that interfere with learning. Signs of possible difficulty with visual motor and visual perceptual issues are listed as items #20 to #38 on the Checklist of Visual Behaviors.  It is not necessary for OT to provide IEP related services in order to request a developmental vision assessment. 

The school occupational therapist is not responsible for opening the assessment plan or facilitating the assessment process.  OT staff will contact their seniors if they have any questions related to vision skills or their roles in the referral process.  

8.9.3       Procedures for Developmental Vision Assessment / Vision Therapy Referral and Assessment 

Notes The best candidate for Vision Therapy is a student who presents as having difficulties with accommodation, refraction, eye alignment (eye or eyes have a tendency to drift), eye teaming (such as difficulty with convergence/ divergence), and eye movement control (fixation, saccades, pursuits and tracking). 

  1. The Case Manager checks the health records to ensure that the student does not require prescription lenses/glasses. If the student has a current prescription for glasses and the student is not wearing them, the referral for assessment process stops until the student starts wearing the prescribed glasses/lenses consistently for at least ten consecutive school days. The case manager monitors student performance and works with site staff to determine: 

    1. If the student no longer demonstrates a suspected need for possible VT services, the referral process will stop.  A prior written notice will be provided to the parent/guardian informing them of the student’s status and the district’s determination not to assess in this area.

    2. If the student continues to demonstrate a suspected need for possible VT services, the referral process will continue. 

  2. The Case Manager contacts the school nurse to ensure that the student has received a current vision screening.  If the student presents with a medically related vision issue, the school nurse will contact the family to encourage the family to follow up with their eye-care provider, and the referral process stops until updated health information has been received. 

    For example, if a vision screening indicates that a student has decreased visual acuity, the IEP team needs to wait to see if the student requires prescription lenses to improve visual clarity. 

  3. The Case Manager prints out copies of the Checklist of Visual Behavior and requests the student’s teachers and parents to complete the form.  Specifically, the language arts teacher rates all items on the Checklist of Visual Behaviors.  The case manager encourages the family to complete and return the checklist.  If all of the completed checklists are rated with “not observed” for all items, then the student does not present with any educationally related areas of need related to vision skills and further assessment or action would not be required.  In this instance, a prior written notice must be provided to the parent/guardian informing them of the district’s determination not to assess in this area. 

  4. The Case Manager shares the completed copies of the Checklist of Visual Behavior with the school occupational therapist (OT).  The OT will review the forms to see if the student presents with visual motor / visual perceptual challenges that school OT can support.  The student may only require OT (instead of VT) if the student presents with educationally related challenges that are limited to visual motor/visual perceptual skills as listed as items #20 to #38 on the Checklist of Visual Behaviors.  If the student does not already have OT listed as a related service, then the school OT would work with the case manager to determine the need for generating an assessment plan for OT. 

  5. The Case Manager, OT Specialist and Classroom Teacher meet to review information related to vision skills to determine if further assessment is required.  It would be helpful if the school psychologist provides input as well.  The IEP team members review the nurse’s screening to determine if the student has a medically related vision issue.  The team members also review the Checklist of Visual Behaviors to see if there are areas of need related to vision that cannot be explained by other learning factors such as not wearing prescription lenses, reading comprehension, attention, motivation, phonemic awareness or motor planning.  The team will document their findings as a rationale to initiate the Developmental Vision Assessment using the Request for Developmental Vision Assessment form. 

  6. The case manager creates a supplemental assessment plan in the district’s electronic IEP system: 

  •    Under “Additional Assessments” select “Developmental Vision Assessment” in the drop down menu and select “Other service provider” for the Examiner Title.

  •    The assessment plan is sent home for parent signature.  Confirm and update contact information (phone # and/or email) for the parent.

  •    Within 3 days of receiving the parent-signed assessment plan, the case manager compiles and submits all forms needed for a Request for Developmental Assessment including:

    • Request for Developmental Vision Assessment form, all sections completed

    • Results of Nurse’s Screening

    • Checklist of Visual Behaviors

    • Exceed-referenced DATE of the most recently consented to IEP, for the VT clerk to access (or send a copy of the current IEP)

    • Parent-signed Assessment Plan, with “date received” by district. 

  1. Mail the entire packet through school mail to “Vision Therapy, Wiggin Center B-8.” 

  2. Once the Developmental Vision Assessment Report has been completed and received by the district, the Case Manager will receive an electronic copy (pdf) of the report from vtclerk@sandi.net, and a letter with instructions to reconvene the IEP 

The case manager schedules a supplemental IEP within timelines to review the Assessment Report with the parent, and provide them with a copy.  This pdf report is attached to the supplemental IEP event as an attachment in the district’s electronic IEP system.  Case Managers are responsible for all IEP events related to Developmental Vision Assessment / Vision Therapy in Exceed, including IEP goals. 

At the supplemental IEP meeting, the team reviews the findings of the Developmental Vision Assessment report to consider if vision is impacting the student’s ability to benefit from the educational program. The team reviews the areas of need and considers the most appropriate related service support (occupational therapy, vision therapy) to address these areas of needs. 

•    If the only assessed area of need is visual motor/ visual perceptual skills related to quality of written output, the IEP team should consider Occupational Therapy as the related service to support this area of need or the IEP team should consider standard accommodations for the student’s written output such as typing written work.  The OT must be present when considering occupational therapy as a related service. 

Vision Therapy Not Required 

If the IEP team reviews the “Developmental Vision Assessment” report and the IEP team determines that Vision Therapy is not required to support the student, this decision must be documented on the IEP Team Action page. 

Vision Therapy Is Required 

If the assessment indicates difficulties with eye movement control, eye alignment, eye teaming or refraction that impact the student’s ability to keep their place when reading and reading comprehension over time and/or math number reversals or proper alignment of numbers after expected time of development of this skill has passed, the IEP team could consider Vision Therapy as an additional related service, as monitored by the case manager. 

If the IEP team determines that Vision Therapy is necessary for the child to benefit from the educational program:

a)  The related service of Vision Therapy would be added to the Services input screen of the IEP (See Exceed Manual page 61) which should include: 

  • number of hours

  • start and end dates

    b)  Complete “Special Factors page 1” as follows:

  • under “Subject Areas/Content Area/ Related Service”, list the areas where vision is affecting the student’s educational program (ex. Reading efficiency, written output)

  • under “Service”, select “Vision Therapy” from the dropdown menu.

  • under “Environment, select “other school/community location”.

  • under “Comments” write, “Vision therapy service includes direct service, collaboration and consultation and requires re-assessment at completion of services to determine ongoing need.”

    c)  Vision Therapy (VT) would be added to those IEP goals related to the student’s educational performance.  Areas of need that were identified in the Checklist of Visual Behaviors can guide IEP teams to possible goal areas that would be appropriate for Vision Therapy to support. 

  1. Once the IEP is completed and locked, a copy is sent to the VT clerk through District mail.  Or, if the IEP team determines that the student does not require Vision Therapy, this information is documented on the Team Action page, a copy sent to the VT office, and the case is then inactivated in the Vision Therapy database. 

  2. A Developmental Optometrist re-assesses a student’s vision ability and progress with Vision Therapy at the end of each authorization period. The Developmental Vision Reassessment report is reviewed at a supplemental or annual IEP as described above in #8 and #9.

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Contact Information:

vtclerk@sandi.net 

Location:

Wiggin Center, B-8