A recent discussion between teachers on a listserv raised the question of whether doctors should be prescribing school-based interventions. This got me thinking about the tension between what doctors think will be best for children, and what educators think will be best. This tension leaves (often inexperienced) parents in a difficult spot — trying to evaluate what is truly appropriate for their child, and what different providers recommend. Children do benefit more quickly when given more intensive instruction — especially in areas like speech/language (including reading, writing, speaking and listening), occupational, and physical therapy. The logistics of how to implement that is what should be up for discussion.
One problem is the distinction between the “medical model” versus the “educational model” (a distinction I personally find confusing – we should all be working together to provide what the child needs). While everyone — parents, doctors, and educators — wants the child to progress as quickly as possible, we all know that the costs of providing these intensive interventions are very high. A doctor is likely to recommend the intensity of intervention that she or he believes is of the maximum benefit to the child, regardless of expense. The parents are left to figure out how to implement a plan that will best support their child, given the very real constraints on their own time and budget.
A second problem is that doctors receive no training in the “educational model,” unless they know how to seek it out. I’m not even sure they can get continuing education credits for attending such training. And most doctors I know are not exactly living a slow-paced life, with lots of extra time to spend researching educational law. The educators among this group know how challenging it is to navigate the system for supporting children with disabilities; I can assure you that parents find it even more challenging because it is so difficult to find training when you have no idea where to look. Doctors are in the same boat with the parents.
Now look at this from the point of view of the parents, who are being told by a doctor that their child needs something (intervention and/or accommodations). They bring the doctor’s recommendation to the school — thinking that the schools also want the maximum benefit for their child. The school (reasonably in some cases, unreasonably in other cases) may decide that a different set or level of supports than those recommended by the doctor is appropriate.
As a parent, how would you feel? You are being told by one expert (a doctor) that your child needs _____. And you are told by other experts (the educators who are with your child for 6+ hours every day) that your child qualifies for less than _____. (This is where the definition of “appropriate” comes into play. I cannot address this issue here. For this post, I assume that in our hearts, we all want what is best for the child.)
The parent might, reasonably, decide that if the school cannot provide everything that the medical expert recommended, that they should supplement what the school is providing with outside therapies. But because the child has a disability, being in school is exhausting for them — much more taxing than it is for children who do not have disabilities. So, they get home, they are beyond tired, and they have to go to a therapy session and work hard in their area of disability. It might make sense to pull a child out during school hours to provide needed therapies, but that solution is fraught with its own challenges.
It’s no secret that having a child with a disability is financially devastating, not to mention the emotional cost of not having time to just be a family.
Parents of kids with disabilities are often left to make draconian decisions about their budget. Because their kids are not making progress at school, I’ve seen many parents make the very difficult decision to quit working or reduce their work hours so they can take their children to therapies. The amount insurance will reimburse for these therapies is often limited by insurance companies in ways that are NOT in the best interest of the child, leaving families to pay the balance if they want to provide what their doctors have told them is medically necessary. How are they supposed to do that when their income has been drastically cut because they have quit their jobs or cut their hours? If they can’t, they may decide to increase their work hours which leads to fewer hours being home with your child, being a parent.
Bringing It Together
It is my wish that when educators are sitting at the IEP table with a parent who has a prescription from their doctor that dictates that a child needs a certain level and type of support, those educators will focus their energy on helping the parent understand what is appropriate and why they feel that way. Parents truly do not know who to believe, and when school teams do things like getting indignant about what a doctor prescribed, or dismissing the recommendations outright, parents feel the school team does not care about their child.
This fundamental tension is at the root of so many bad feelings between medical providers, parents, and educators. We need to recognize that we are all members of a team dedicated to supporting a child in the best way possible. We each have different views about what will be best for the child based on our training, experience, and understanding of the child. We need to take the time to educate each other based on our own points of view.
We should be partners in the process.