Including Related Services in Your Child's IEP

When a student with a disability qualifies for Special Education, they are able to receive "specialized instruction" or "specially-designed instruction." Specialized instruction is designed to meet the needs of a particular student, so that they can learn and make progress to the level of their ability. It may be different from typical instruction in one or more ways, including:

• what is taught

• how it is taught

• who teaches it

The IEP team should determine how a child learns each academic subject, including:

• math

• reading

• writing

• science

• social studies

• arts

• health

Then, they can determine what kind of specialized instruction a child needs, and for which academic subject areas.

Related services can be offered in multiple ways, depending on a student's needs and preferences. For example, related services providers could service a child:

• in their regular classroom

• in a separate classroom or space

• at the child's home

• in an afterschool or recreational setting

• in a job setting

• through consultation with their other teachers

Keep reading to learn about the related services that a child may require.

Please note: in an effort to make this article as useful as possible to parents, it categorizes related services slightly differently than does the Individuals with Disabilities Education Act (IDEA). Readers are invited to read the original law below.

When a student cannot fully and safely participate in a regular physical education (PE) class at school, they can qualify for adapted PE. Sometimes, adapted PE is considered specially-designed instruction, and sometimes it is considered a related service. The category does not really matter so long as the student is receiving the help they need.

Adapted PE is designed for a particular student by an adaptive PE teacher, and can include:

• evaluating the student to determine their strengths, goals, and needs

• designing a curriculum that builds on the student's current skills and develops new ambitious but attainable skills

• selecting activities and teaching methods that are safe for a student, and that are designed around that individual student's body

• ensuring that the student's PE coursework is as inclusive as possible, and allows the student to participate alongside peers

• providing extra supervision for the student, or teaching the student in a smaller group

Students may require some form of adapted PE if they:

• cannot independently walk, run, jump, climb, throw, catch, and/or kick

• can be injured more easily than other students, or can have a serious reaction to an injury

• have reduced endurance, strength, coordination, and/or flexibility

• are very sensitive to heat

• get tired very easily

• often fall over

• often faint

• have frequent seizures

• have low oxygen saturation, and/or require supplemental oxygen

• become ill with physical exertion

• become overwhelmed and are unable to meaningfully participate in a regular PE class

• have an intellectual disability (ID) that makes it hard for them to understand and follow directions and rules

In many cases, a student's needs can be met with accommodations, modifications, or additional educators within the general education PE classroom. Sometimes, a student requires a separate or smaller PE class in order to have access to an appropriate education.

Applied behavior analysis (ABA) is the scientific study of understanding and shaping human behavior. Students with disabilities may require ABA in school for a variety of reasons. For example:

• Sometimes, children learn best when ABA is used as the method of instruction. ABA is HOW a teacher designs and delivers their lessons, and records what the child is learning. In these cases, ABA may not be considered a "related service," and instead might be considered part of the child's "specialized instruction." The label does not usually matter as long as the child receives the services they need.

• Sometimes, children engage in behaviors that make it hard for them to participate in the classroom and to learn. In these cases, ABA can help to understand the causes of children's behavior, and to design a plan to help the child change their behavior so that it does not interfere with their learning and goals.

Depending on a student's individual needs and goals, ABA services could include:

• evaluation through a functional behavioral assessment (FBA)

• designing a plan for what the child will be taught, when, and how

• designing a behavior plan that will define how staff can shape an environment that maximizes a child's chance of success, and how they can respond to both wanted and interfering behaviors

• following a behavior plan

• taking data to track how a child responds to different strategies and interventions, and then using this data to make informed decisions

• monitoring both instruction and behavior management, consulting with teachers, and training teachers

• directly teaching a child using discrete trials or other ABA methods

• training a child's parents or other caregivers

• providing behavior support in a child's home

Students who are Deaf or hard of hearing often need audiology services in order to have full access to the curriculum. For example, they may require:

• testing to determine if they have hearing loss, and the type or extent of their hearing loss

• selecting and providing tools that help a child to hear at school, such as an FM system or personal amplification system

• teaching children to:

  • be more aware of sounds

  • tell the differences among sounds

  • match sounds with words and meaning

  • speak more clearly and effectively

  • build skills in oral (spoken) language, manual (signed) language, and/or written language

  • develop communication skills beyond language, including gestures, facial expressions, and visual cues

  • understand their own profile and self-advocate

  • manage their own hearing aids or other hearing systems

• a live person interpreting a spoken language into a signed language in real time

• a live person interpreting conversations between a student who uses a signed language, and other people who use a spoken language

• live cued oral language

• translation of written text into a signed language

• real-time written transcription of spoken language

Public schools are required to make sure that students are able to remain safe and healthy while they attend school.

Most children can have their health managed effectively by existing school nurses, but some children require more medical support than a school typically offers. In these cases, schools must either hire additional medical professionals for their building, or pay for a child to attend a school that can meet the child's medical needs.

Students can require additional nursing for many different reasons, such as:

• tube feeding during the school day

• supplemental oxygen during the school day, and/or a need to monitor oxygen saturation

• a seizure disorder that is not well-managed

• administration of medication during the school day

• needing to warm up and cool down with supervision before and after exercise

• a high risk of choking or aspiration

• ostomy bag

• use of a urinary catheter

• tracheostomy, ventilator dependence, and/or a need for suctioning of a child's airway

• adrenal insufficiency

• diabetes that requires ongoing management

• allergies associated with anaphylaxis

• high risk of falling and/or fainting

• severe psychiatric disorders that require medical management and/or monitoring vital signs

• a high risk of medical emergency requiring a quick and specialized response

Depending on individual needs, schools may need to provide a student with services such as:

• a nurse assigned to the student's school building (in a building that did not previously have a nurse)

• an additional nurse or physician's assistant assigned to a student's building (in a building that already had one or more nurses)

• a one-to-one nurse or physician's assistant assigned to the student in the school, on the bus, and at off-property school events

Families can talk with their medical team to determine what nursing services a student requires in order to attend school safely. When a student has complex needs, it can be helpful to have regular meetings and ongoing communication among the family, the school nursing team, and the hospital team.

Occupational therapy (OT) focuses on helping people to participate as fully as possible in their daily lives. Occupational therapists have expertise in helping people with many different types of activities, including:

Sometimes, people think that school occupational therapists can only help with handwriting. This is not true. Occupational therapists can help to remove barriers to students' participation in any part of their life at school. Parents can work with their school teams to thinking broadly and creatively about whether and how occupational therapy could help a student at school.

Students who are blind or visually-impaired often require orientation and mobility services at school from a certified Orientation and Mobility Specialist (COMS). These services can include:

• assessing a student's needs and goals

• determining required accommodations and modifications

• teaching the student how to find places, objects, and people

• a sighted guide during the school day

• providing mobility and orientation tools and technology, such as a cane

• teaching the student how to use different orientation and mobility tools and technology, such as a cane

• teaching strategies to stay safe and protected in unfamiliar or risky situations

• teaching the student how to travel in the school, on the playground, and in the community

• training and consulting with the student's parents, teachers, and other school staff

• teaching the student how to compensate for their vision loss when performing schoolwork, job skills, and life skills

• helping the student to understand their vision needs, and to self-advocate

IEP-based parent training could include teaching parents:

• about the child's disability

• about child development in general, and their own child's development in particular

• how to use a behavior plan at home

• how to use an alternative or augmentative communication (AAC) device or system

• how to assist someone who is using a cane for orientation and mobility

• how to use assistive technologies

• how to set up a morning schedule to help the child transition to school

• how to practice skills taught at school while the student is at home

Students with congenital heart defects (CHDs) often require physical therapy (PT) at school as part of their IEP. Physical therapy can help them to build and maintain physical strength, flexibility, coordination, and endurance, and can often help them to participate more fully throughout the school day.

Students often qualify for school-based physical therapy if they:

• have trouble moving around the school building safely and independently

• get very tired during the school day

• cannot easily sit up straight, with their head up, for the amount of time expected in a school day

• cannot use the playground equipment as well as their peers

• struggle to keep up with peers in physical education (PE) and recess

• are still learning to stand, walk, run, jump, kick, throw, catch, and/or climb

• have trouble sitting in school chairs or on a classroom rug

• cannot use both sides of their body equally well

• struggle to complete tasks that require them to pass objects from one hand to the other, or to use both sides of the body at the same time

• often fall, or are unsteady on their feet

• cannot go up and down stairs safely and independently

• need help getting into and out of a van or bus seat, or onto and off a toilet seat

• are learning how to use mobility devices such as a wheelchair, crutches, or cane

• are recovering from an injury, illness, or procedure that affected their strength, movement, coordination, and/or flexibility

• have pain in their body during the school day

• need help getting access to their learning materials in the classroom

Physical therapists can provide direct services to a child, and can train their teachers and parents. They can also help determine what accommodations a child may need in the school in order for the child to remain safe and included.

Students with disabilities often require services from a psychologist in order to fully benefit from their education. Psychologists can help in two primary ways:

1. Most students with disabilities undergo an evaluation with a psychologist as part of the process to qualify them for Special Education. This initial psychological evaluation helps the team know if the student requires Special Education, and to understand their strengths and needs. Generally, a psychologist reevaluates a student at least every three years to measure their progress, and to determine if they still require Special Education.

2. In addition to testing, psychologists can also serve students through counseling or therapy. They can meet with students individually or in groups, and help the students to better understand and manage their thoughts, feelings, and behaviors. They can also train a student's parents and teachers to understand the student better, and to care for them more effectively.

Students are likely to require ongoing psychological services at school if they have thoughts, feelings, and/or behaviors that interfere with their capacity to learn at school.

Public schooling is intended to prepare students to participate in their adult lives as well as they are able. Some students need extra support in learning how to use their free time, and how to integrate into their communities. These students may qualify for recreation services on their IEPs.

Recreation services can include:

• Testing a student to understand their recreational skills, needs, goals, and interests

• Teaching and practicing skills that will allow a student to participate in more recreation activities. For example, a student interested in a bowling league might work with a physical therapist to build the strength and coordination required to lift a ball and roll it down a lane.

• Leading a student in recreational activities that build thinking skills such as attention, planning, organization, decision-making, strategizing, and problem solving, and creativity. For example, a student might participate in board games, art activities, or a sport in order to develop these skills.

• Leading a student in recreational activities that build social-emotional and behavioral skills, such as turn-taking, self-regulation, calming strategies, making and keeping friends, and conflict resolution. For example, a student might participate in a group sport, a drama club, an art class, or a music group in order to build these skills.

• Teaching and practicing recreational activities so that a student has more opportunities for participation. For example, a student could learn the rules of soccer, and practice playing soccer, so that they would have the opportunity to join a local soccer league or club.

• Teaching students how to find and use recreational opportunities in their communities.

School-based recreational services are most common among older students with intellectual disabilities (ID). However, they can be included in IEPs for younger students, and students with typical thinking and learning skills. When parents understand these services, then they can advocate for them as needed.

• helping a student decide what kind of work they want to do, and to define their career goals

• supervising students in a supported work setting

• teaching and practicing independent living skills, such as self-care, managing a household, preparing meals, budgeting, and travel

• teaching and practicing moving around a student's community, doing errands, and finding and using community resources

• supporting a student in finding and joining community groups

Students often start receiving rehabilitation counseling through their IEP when they are about 14-16 years old. However, these services can start earlier if needed.

Social workers have a diverse skillset, and can help students with disabilities in multiple ways. In an IEP, social work services can include:

• Therapy or counseling with individual students, groups of students, and/or students and their families.

• Learning about a student's history, and writing a report about relevant parts of their history to share with the IEP team.

• Working with families, schools, and community organizations to solve problems in the child's life that are interfering with the child's ability to learn at school. For example, this could mean helping the family to find stable housing, home-based behavioral support, parent therapy, access to nutritious food, home nursing, or affordable transportation.

• Helping to design and manage a behavior plan for the student.

• Advocating for the child's broader needs within the IEP team.

When planning social work services, families and other providers can think broadly about a child's needs, and consider all the factors that may be limiting their capacity to benefit from their education. For example, they can ask if the child is:

• eating well and enough?

• able to stay clean and appropriately clothed?

• living in safe and stable housing?

• receiving appropriate medical and dental care?

• sleeping enough?

• living with adults who provide necessary care and attention?

• able to get up on time and follow a schedule along with their family?

• safe from emotional and physical violence?

• able to travel with their family to and from school, and around the community?

• able to regulate their emotions and behavior?

• able to participate in safe recreational activities with peers and family?

• emotionally stable?

Whenever a condition in a student's life interferes with their ability to learn at school, school social workers can and should try to help.

Speech and language therapy can help many students with disabilities learn to their potential. Speech and language therapists can help students with any aspect of speech, spoken and written language, or communication, including:

• understanding spoken language

• participating in conversations

• pronouncing sounds and words clearly

• grammar (using the correct forms of words, and putting words in the correct order)

• using and understanding more words

• social communication

• reading comprehension

• speaking and writing longer and more complex sentences

• using abstract and nonliteral forms of language

• telling a story

• speaking smoothly and fluently, with less stammering and stuttering

• explaining and organizing ideas in writing

Speech and language pathologists also have expertise in how the mouth works in general, beyond just how the mouth is used for speaking. So they can help students with:

• safely eating, drinking, and swallowing

• strengthening and coordinating muscles in the mouth and throat

• reducing drooling

Public schools must make sure that students with disabilities can travel freely and safely:

• to and from school

• to and from school programs

• within a school building

• between school buildings

Some children with disabilities need transportation services in their IEP, such as:

• travel to and from school in a smaller school bus

• pick up and drop off at their door

• a nurse who can travel on a bus with the child to and from school

• a paraprofessional who travels with the child on the vehicle

• a bus or van with ramps, particular seats, harnesses, lifts, air conditioning, or other special features

Sometimes, a parent may drive their child with a disability to or from school or a school program. This can happen if a parent prefers to drive their own child, or if the school is unable to provide an appropriate mode of transportation for one or more days. If a parent drives a child who cannot take regular school transportation, then the school district must financially reimburse the family for each trip.

Public schools are an immensely rich resource for children with heart defects and other disabilities. They are required to provide children with a free and appropriate education, and to offer those children any services they require in order to fully access that education, and to make meaningful progress. When parents, clinicians, and educators are aware of the fully range of available services, they can better serve their students, and equip students with disabilities with the knowledge and skills they require in order to meet their goals.

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.