Special Education Compliance. It's Not Enough!

Special Education Compliance

“It’s Not Enough!”

Over the last week there has been an increased focus on special education in the United States. President Obama began on Tuesday in a press conference, by stating some facts that there are over 6.5 million students with disabilities within our national public school systems. To many parents who have children with special needs, this figure may not be a shock.

According the ED.gov blog, Higher Expectations to Better Outcomes for Children with Disabilities, “While the vast majority of students in special education do not have significant cognitive impairments that prohibit them from learning rigorous academic content, fewer than 10 percent of eighth graders with disabilities are proficient in reading and math on the National Assessment of Educational Progress (NAEP)……compliance is simply not enough” (ED.gov, 2014).

While the majority of states (besides DE, IA, IL, ME, MO, NC, NM, NY, OK, TX, RI, District of Columbia and other territories) met the requirements for IDEA state compliance, the data for math and reading proficiency among students with disabilities left a disturbing picture for the Department of Education. Only 18 states and territories actually met the expected requirements for how students are performing.  Below lists the states in the three categories outlined as either meeting requirements, needing assistance, or needing interventions:

The new suggested budget for 2015 included the Results Driven Accountability (RDA) Incentive grants in the form of $100 million as well as a Race to the Top Equity and Opportunity ($300 million) program to aid in identifying districts/schools with achievement gaps that require assistance. The states who receive these grants must demonstrate “commitment to using results data in their IDEA-required LEA determinations, consistent with the Department’s (DoE) RDA system, to support their efforts to implement evidence based practices that have demonstrated a positive impact on results for children with disabilities” (Department of Education, 2014). 

Michael Yudin, acting Assistant Secretary for Office of Special Education and Rehabilitative Services, states that 

“In enacting IDEA, Congress recognized that improving educational results for children with disabilities is an essential element of our national policy of ensuring equality of opportunity, full participation, independent living, and economic self-sufficiency for individuals with disabilities” (Ed.gov, 2014). 

What seems paramount here is the focus on many skills which are not primarily academic and seem to be missing from the current focus. These kinds of functional goals are every bit a part of IDEA as the academics, and for good reason! 

Accountability for states to continue raising the bar for our children with special needs has parents going on both sides of the fence. Looking forward to a much needed oversight for how states and school districts provide services to attain academic goals for students with disabilities. There are also parents who are concerned how the functional goals will begin to compare with such an emphasis on the academic achievements that will put further pressure on schools. Standardized testing has long had concerns about its ability to accurately assess children, particularly those who have disabilities.

According to an article by the National Center for Learning Disabilities (NCLD, 2014)

 “For many students with learning disabilities, with or without accommodations, standardized tests are among the worst means of assessing their abilities. Given the individual learning styles of students with LD, at DRA we feel these high stakes tests pose considerable danger to a student. A student’s performance on a high stakes test has serious consequences, but we’ve found that these tests usually don’t measure the student’s capabilities in a realistic way. Often, standardized tests are poorly devised and give very little consideration to how valid an assessment they provide of students with LD.”

After a case in Oregon, Advocates for Speak Kids (ASK) won regarding this very issue, and Oregon took extensive steps in 2001 to ensure it does not discriminate against students with learning disabilities but instead able to demonstrate their disabilities. Yet if we look at the 2014 data, Oregon is one of the states in yellow for needing additional assistance. 

Our military families in particular have unique struggles within the special education system as highly mobile families. Multiple moves during a military career mean multiple changes in schools and having to move with an IEP can often be trying for parents who do not find their children getting what has been deemed "comparable services." By the time a school and parents have the chance to accurately identify needs and and the correct services to make measurable progress, a child is often not far away from another move. Meanwhile there is the very real potential for regression while the process starts all over again. 

Not long after this, NPR (National Public Radio) conducted an interview with Education Secretary Arne Duncan to further discuss this identified issue. The apparent focus for the Department of Education is the raise an academic bar for children with special needs in order to sustain their ability to be competitive in the global economy after high school.  What has been suggested is to use more forms standardized testings to measure these academic gains of those students with disabilities.

Secretary Duncan made comments regarding increased dropout rates for children with disabilities and how there has never been a requirement for states to show academic benefit for special education, but he intends to change that. 

 “We know that when students with disabilities are held to high expectations, have access to a robust curriculum, they excel,” Secretary Duncan states (NPR, 2014). 

For states to continue receiving special education funding, which totals more than $11.5 billion nationally, they will be required to comply with these new guidelines and subject to oversight. The Department of Education also plans to roll out a new $50 million technical-assistance center to help achieve these expected outcomes. 

As states continue to grapple with the issues of common core standards and how these can better apply to our children with special needs, switching to more standards based grading/IEP goals, and other potential issues, parents will have to wait to see how these new guidelines play out.
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Will the oversight be welcomed by parents and educators alike to help assist in providing better outcomes, or will we see an impact on services and eligibility for special education?

No matter the changes in these guidelines and the new oversight, it is important to remember that Individuals with Disabilities Act (IDEA) has not changed as an individual entitlement for our children with special needs. These special education services as provided under an IEP or IFSP, will continue to be driven by the individual child’s need and does not negate the importance of both functional and academic goals that is defined in IDEA specifically. Parents may just find themselves having to advocate more for these functional goals in the face of pressures for academic performance from higher up.

Resources

Ed.gov Blog (June 27, 2014). Higher Expectations to Better Outcomes for Children with Disabilities 

Disability Rights Advocates (2001). Do No Harm.

National Center for Learning Disabilities (NCLD) The Trouble with High-Stakes Testing

National Public Radio (NPR), June 24, 2014, A ‘Major Shift’ in Oversight of SpecialEducation 

U.S. Department of Education, 2014. Results Driven AccountabilityGraphics.

U.S. Department of Education, 2014. Supporting Individuals with Disabilities. 

ABA Updates Begin to Take Effect July 25, 2014

ABA updates released in the Federal Register

The June 16, 2014 Federal Register contains important information regarding changes coming to Tricare’s three ABA programs (Tricare Basic interim, Autism Demonstration under ECHO, and the Autism Pilot for Non-Active Duty). The action read “notice of comprehensive demonstration project for all Applied Behavior Analysis (ABA), including the tiered model of ABA, for all Tricare beneficiaries with Autism Spectrum Disorder (ASD).” 

Essentially, beginning July 25, 2014, one day after the end of the current pilot, Tricare will begin to provide ABA services under one united program called the Autism Care Demonstration. Qualifying beneficiaries with autism will now be able to have the same access to care, regardless of the Tricare plan or status (Active Duty, Reserve, Retired, etc). Little is still known how this will begin being implemented other than it will occur in a phased approach from July 25, 2014 until its completely turned over by December 31, 2014. The Autism Care Demonstration is set to run until 2018 at the current time. 

Below described our breakdown of the new Autism Care Demonstration. If you would like a condensed version, scroll to the end to view our Quick Facts. 

Autism Care Demonstration (Information as of June 16, 2014)
When:	To begin transitioning July 25-Dec 31, 2014 and continue through Dec 31, 2018
Who:	For all beneficiaries who meet criteria/program requirements, regardless of Tricare plan and to include both activity duty and non-active duty sponsors
What is included:	·        Initial ABA Assessment ·        Functional Behavioral Assessment and Analysis ·        Development of an ABA Treatment Plan (TP) to include goals and objectives and specific evidence based interventions ·        One-on-one ABA interventions ·        Assessments in accordance with Treatment Plan ·        Periodic ABA TP updates that reflect re-assessment of progress
How much will it cost:	·        No annual cap ·        Active Duty will pay the monthly ECHO cost share based on pay grade to satisfy Autism Care Demonstration for ABA provided by BCaBA and/or Technicians ·        Non-Activity duty cost share at 10% for BCaBA and/or Technicians ·        One on one ABA by BCBA/BCBA-D will be equal to regular cost sharing under basic program (based on Prime, Standard, Extra, etc) ·        Cost share is outside Tricare basic catastrophic cap ·
Purpose:	Said provide the opportunity to analyze and evaluate the following: ·        Appropriateness of ABA tiered delivery model ·        Appropriate provider qualifications within framework of Board of Certified Behavior Analyst current guidelines ·        Determine the appropriate provider qualifications for proper diagnosis of ASD and need/referral for ABA ·        The value of tutors, or Behavior Technicians in addition to ABA provided by BCBCAs ·        Assess the need and feasibility of a beneficiary cost share for treatment of ASD ·        Develop more efficient means if access and delivery of ABA services ·        Assessment whether ABA should be considered an educational service or medical ·        Under what parameters should it be provided (age, length of treatment, etc) ·        Assessing the charactericts of beneficiaries who do and do not utilize the BCBCA only benefits ·        Determination of specific factors which contribute to non-utilization of only BCBA delivery ·        Which beneficiary age groups benefit most ·        Relationship between utilization of medical services (such as OT, PT, Speech, etc) and ABA
Requirements for beneficiary:	·        Beneficiary must have a diagnosis of ASD by a provider who is capable ·        Even though it will officially begin on July 25, 2014, it will be implemented in a phased approach with a target date for all beneficiaries to be transitions by December 31, 2014 ·        Active Duty will still be required to register for ECHO (Extended Care Health Option) ·        ABA will be considered an ECHO registered service necessary to qualify for respite
Referrals/Authorizations:	·        Beneficiary must have a diagnosis of ASD by a provider who is capable then the diagnosing provider will submit a referral to the Tricare regional contractor o   PCMs (such as nurse practitioners and physician assistants, etc) who do not have specific ASD qualifications may not refer ·        Tricare regional contractor will issue a one year authorization from a Tricare authorized BCBA or BCBA_D ·        Prior to authorization expiration, BCBA or BCBA-D will request re-authorization based on documented reasoning for continued ABA included an updated treatment plan ·
ABA authorized providers:	·        A BCBA or BCBA-D must serve as an “ABA Supervisor” who will create and modify behavior plans, deliver and/or supervise ABA programs o   Minimum of a Masters Degree ·        Tutors or Behavioral Technicians may support ABA supervisors by working under then and providing one-on-one with the beneficiary with ASD
Tests/Assessments:	·        For patients who have an ASD diagnosis not met by authorized specialty ASD provider, an ADOS-2 is required within first year of ABA, to confirm diagnosis ·        Progress to be presented by BCBA/BCBA-D every 6 months o   Must be in graphic form, and/or standardized assessment measures (ie ABLLS-R), or the Verbal Behavioral Milestones Assessment and Placement Program (VB-MAPP) ·        Annual Vinneland-II testing is covered but is not a requirement Must submit documentation of clinical progress annually to referring provider and regional
Discharge Criteria:	Considered by regional contractor when ABA is no longer considered appropriate ·        No measurable progress made toward meeting goals in ABA treatment plan after a number of review periods and repeated modifications to TP ·        ABA TP gains are not generalizable or durable over time and do not transfer to larger community (to include school) after repeated modifications and progress reviews ·        Patient can no longer participate in ABA (due to medical factors, family problems or other factors that prohibit participation) ·        Patient has met ABA TP goals and is no longer in need of ABBA ·        Loss of eligibility for Tricare benefits
Program evaluation:	Program will be evaluated by parental surveys in 2016 and 2018 ·        Questions will be targeted on the following topics: o   Reasons why parents use ABA benefit o   ABA by BCBA/BCBA-D only vs no ABA o   Parent’s perceived impairments of child with ASD o   Difficulty in accessing/obtaining ABA and other clinical services o   Overall satisfaction with the benefit
Overseas- Tricare Overseas Program (TOP)	·        Must be provided directly by a BCBA or BCBA-D in countries where they have certifications by the Behavioral Analyst Certification Board (BACB) ·        ABA by tutors or technicians is not authorized

 For a quick overview here is a condensed breakdown of information:

QUICK FACTS SUMMARY

•         Active Duty must be registered in ECHO •         Must have ASD diagnosis by Tricare authorized PCM or Autism specialist who will submit the referral (If do not have a diagnosis from a qualified ASD provider, must conduct an ADOS-2 to diagnosis within first year) •         ABA services under Basic, Demo and Pilot will be transferring to Autism Care Demonstration between July 25 and Dec. 31, 2014, and will be in effect through 2018. •         Two delivery models: direct service by BCBA/BCBA-D and direct service by a BCaBA/tutor •         Costs shares: Non activity duty 10%, Activity Duty will pay monthly ECHO fee for services provided by BCaBA and/or Technicians/tutors •         No annual Cap •         Discharge criteria: no measurable progress, no generalization or no durability of gains, no generalization of goals to other settings, no participation of patient (due to medical problems, family problems or other) •         Progress to be measured weekly in graphic and or/standardized measures and submitted annually to referring provider as well as Tricare regional contractor •         Tricare Overseas Program(TOP)- only authorized for services under BCBA/BCBA-D •         All ASD patients will have the same access to care, regardless of sponsor status or plan.

For more information please visit: 

Tricare.mil- Applied Behavioral Analysis (ABA) 

6/16/2014  Autism Care Demonstration Simplifies TRICARE ABA Benefits

6/16/2014 TRICARE ABA Pilot Benefits Extended

6/16/2014 Federal Register-Comprehensive Autism Care Demonstration