Quick-Guide: Creating Positive Behavioral Supports

1. Get a Little Help from Your Friends
2. Establish Shared Expectations About the Student's Educational Program
3. Understand Your Posture or Attitude Toward the Student Who Has Difficult Behaviors
4. Consider the Message Behind the Behavior
5. Help the Student Feel a Sense of Control over the Classroom Environment
6. Share Information with the Student's Classmates
7. Focus on the Prevention of Problems
8. Teach New, Positive Skills that Will Help the Student Interact and Communicate
9. Respond in Positive, Supportive Ways When the Student Is Having Difficulty
10. Evaluate Your Teaching and Your Interactions with the Student

Quick-Guide: Including Students with Disabilities in the Classroom
Michael F. Giangreco

1. Get a Little Help from Your Friends
2. Welcome the Student in Your Classroom
3. Be the Teacher for All the Students in Your Classroom
4. Make Sure All the Students Are Part of the Classroom Community
5. Establish Shared Expectations About the Student's Educational Program
6. Have Options for Including Students in Class Activities When Their Needs Vary
7. Provide Learning Experiences that Are Active and Participatory
8. Adapt Classroom Arrangements, Materials, and Strategies to Facilitate Effective Instruction
9. Make Sure Support Services Are Really Helping You Teach All the Students in Your Class
10. Evaluate the Effectiveness of Your Teaching

Quick-Guide: Building Partnerships with Parents
Linda A. Davern

1. Send a Clear and Consistent Message Regarding the Value of the Child
2. Put Yourself in the Shoes of the Parents
3. Demonstrate an Authentic Interest in Parents' Goals for Their Children
4. Use Everyday Language
5. Talk with Parents About How They Want to Share Information
6. Expand Your Awareness of Cultural Diversity
7. See Individuals - Challenge Stereotypes
8. Create Effective Forums for Planning and Problem Solving
9. Support Full Membership for All Children
10. Perservere in Building Partnerships with Parents

Consultant Model - In a building with a low incidence of special needs students and overall low student population, this model would be very compatible. The special education teacher is made available to reteach a difficult skill or to help the student(s) practice a newly acquired skill. This is a non-intrusive approach that provides the special needs students with at least two teachers to ask for help with curriculum problems. Regularly scheduled meetings are recommended rather than communica tion on an as-needed basis.

Teaming Model - The special education teacher is assigned to one grade level team with one planning period per week for the team. The special ed teacher provides student information, possible instructional strategies, modification ideas for as signments/tests, and behavior strategies. The team meets on a regular basis, establishing consistent communication among the team members. The team model is presented so teachers are not working independently to achieve success with their students. All team members work together and broaden their knowledge in various areas, whether they are from general education or special education.

The disadvantages of this model could include possible resistence to implementing the modifications, delayed assistance for students with difficulty, high student to teacher ratio, and limited opportunities for special ed teachers to work in the gener al education classroom.

Collaborative, Co-teaching Model - Using this model, the general education and special education teachers work together to teach students with/without disabilities in a shared classroom. Both are responsible for instruction planning and deliver y, student achievement, assessment, and discipline. Students receive age-appropriate academics, support services, and possible modified instruction. This model provides a minimum of scheduling problems, continuous and ongoing communication between educat ors, and lower student to teacher ratio than the teaming or consultant models.

Welcoming parents into a classroom and school is vital to having them be part of the team for inclusive education. Parents of students with disabilities are often the driving force behind the push for inclusive education.

Parent education is the other key to help parents who may question the academic validity of inclusive education. Some parents may think their children will not make the same academic gains in an inclusive setting as students in a rigorous academic clas s. Susan Etschedit (UNI) states research shows the opposite is true. " Not only are all students making strong academic gains, but the literature clearly documents social, interpersonal, and personal gains. An inclusive setting not only does not detr act from the usual education program, but it enriches the educational environment for all children. We have empirical research to validate this information and, more importantly, teacher testimony to tell us how inclusive education works."

While many parents may not like an active classroom and may think their children are not able to learn in that environment, studies show that few students consider an inclusive setting disruptive. A recent survey of 90 sixth graders at a school in Dubuque, Iowa, found only 3 students who said they felt their inclusive classroom was disruptive. -- Chris Macfarlane, Associate Professor of Special Education, UNI

On the other hand, parents of students with disabilities are most concerned that their child will be teased or harmed and not be safe. Again, Macfarlane states that in almost every instance after two years of integrated education, this was not a probl em or the problem was very small. " The reality is that all kids are teased at school," she notes, "so let's work on teasing and helping children understand it is not acceptable."

Parents may support inclusive education when they understand one of its goals is to keep students in their neighborhood school, a school where siblings may attend. (See legal section concerning legal requirements of modifying students' educational pro grams.) This makes it easier for parents who may be more comfortable becoming part of a school community that they already know.

Currently, 11-12% of all students are identified as having a disability. Having students be part of an inclusive setting means that as when those students become parents, they will see inclusion as how education is and not think it is something to fig ht for.

"An Individualized Education Program (IEP), which is required by the Individuals with Disabilities Education Act, is a plan for an education program specific to an individual. This plan is developed collaboratively by the school and the parents. The regulations require meetings between school personnel, parents, and other individuals as well as written documents."

"The Individualized Family Service Plan (IFSP), which is also required by IDEA, is a written plan for infants and toddlers from birth to three years old who receive early intervention services. The regulations requires that children receive early intervention services in "natural" environments (settings which are natural and normal for the child's age peers who do not have disabilities) to the maximum extent possible. Like the IEP, the IFSP must be written with the family's involvement and approval."

1. What is Children's Choice?  Children's Choice is a program designed to help families who provide in-home care and support for their children with developmental disabilities.  Children's Choice assists by providing funding for medical care, home modifications, care-giving assistance and support, and other specialty services.  Children's Choice is a support program designed to be flexible enough to let families choose when they need the covered services.

Children's Choice is intended to supplement the care and support that eligible children already receive at home, through their extended families or that is already available within local communities.  Funds available through Children's Choice are capped at $15,000 per care plan year.  Participants are also eligible for services through the Medicaid State Plan which includes all medically necessary services.

2. What are the eligibility requirements for Children's Choice?

• Child is on the  Request for Services Registry.
• Child is under nineteen (19) years of age.
• Child is disabled according to SSI criteria.
• Child requires the level of care provided in an ICF/MR facility (institution).
• Child has income less than three (3) times the SSI amount (about $1,656).
• Child has resources less than $2,000.
• Child meets all Medicaid non-financial requirements (citizenship, residence, Social Security number, etc.).
• Child's plan of care meets the health and welfare needs of the child.

• Appropriate level of care can be provided outside an institution.

3. What services are available through Children's Choice?

• Case Management
• Family Support (in-home respite and PCA-like services)
• Center-based Respite
• Environmental Accessibility Adaptations
• Family Training
• Diapers for ages three (3) years and above

• Medical coverage via the Medicaid program

4. What are some of the things that would be covered by the Medicaid card? When a child is certified for Children's Choice, they will be entitled to receive medical services and get a Medicaid card.

Some services include physician services, hospital services, home health, additional personal care services, durable medical equipment, pharmacy services and many others.

5. What is the NOW Waiver? The NOW Waiver is a comprehensive community-based waiver program that serves both children and adults with developmental disabilities.  Traditionally, Medicaid pays for and provides services for these individuals in institutional settings.  Through the waiver program, citizens with developmental disabilities have greater flexibility to choose where they want to live, and the services and supports that best suit their needs, while still receiving Medicaid benefits.

The NOW Waiver pays for services such as personal care attendants, environmental modifications, assistive devices, respite care and many other services.  In addition, day/vocational services and residential alternatives (such as supervised independent living and extended family living) are provided.

6. How can a parent find out what their child's request date is on the Request for Services Registry? A parent can call Toll Free 1-866-783-5553 to obtain their child's request date.

7. How often are the opportunity letters offering Children's Choice to families sent out and will families who initially declined Children's Choice be contacted again in the future to see if they have changed their mind, especially if there are changes in the program? When Children's Choice opportunities are available, letters go out to families.  Families who have initially said "no"  will be contacted again based on the availability of opportunity for services.

8. What if I think my child needs more services in excess of the yearly limit?Children's Choice is designed for children under age nineteen (19) with low to moderate needs and whose families provide most of the care and support.  But if a crisis situation develops and additional supports are warranted, there are crisis provisions designed to meet the needs of families on a case-by-case basis. 

9. I've waited several years for community services.  If I accept Children's Choice instead of the NOW Waiver, do I lose the opportunity to get a  Waiver if my child's needs change? If a child's needs significantly change and the crisis or non-crisis designation is met, the child's name would be returned to the Request for Services Registry with the child's original request date.  There is also an administrative appeal process for families who request and are denied either crisis or non-crisis designation.  Additionally, once your child turns age nineteen (19), and continues to meet the eligibility criteria, your child would transfer to an appropriate NOW Waiver.

10. If I take Children's Choice and my child's name comes up for NOW Waiver services before he/she reaches age nineteen (19) can I transfer to the NOW Waiver? It depends on whether or not crisis or non-crisis designations are met.

11. What are the non-crisis provisions? The non-crisis provisions allow Children's Choice Waiver recipients to have their names restored to the Request for Services Registry for the NOW Waiver.  Names are restored to the registry in original date order, when all of the following four (4) criteria are met:

• The recipient would benefit, based on significant changes from baseline assessments, from services through the Waiver that are not actually available through his/her current waiver or through Medicaid; AND

• The recipient would qualify for those services, based on significant changes from baseline  assessments, under the standards applied in granting and denying the services to the NOW Waiver's participants; AND

• There has been a change in circumstances, based on significant changes from baseline  assessments, since the recipient's enrollment in the Children's Choice Waiver causing these other services to be appropriate.  This does not require that there has been a change in the recipient's medical condition, but can include loss of in-home assistance through a caretaker's decision to take on or increase employment, or to obtain education or training for employment.  Vacations outside the continental U.S. are not considered "good cause"; AND

• The recipient's request date for the NOW Waiver has passed on the Request for Services Registry.

12. If a crisis occurs and additional services are needed beyond the cap, how long will it take to access those services? When the crisis occurs, the family should contact the case management agency to convene the team to evaluate the need and to request approval of the needed services.

13. What happens when my child reaches age nineteen (19), and Children's Choice benefits expire? Once your child turns age nineteen (19), and continues to meet the eligibility criteria, your child would transfer to an appropriate MR/DD Waiver.  Approximately ninety (90) days before your child turns nineteen (19), this eligibility and transfer process would begin.

14. I've been told that some of the $15,000 is used for mandatory case management.  Can I forgo these services and instead use these funds to purchase additional community-based services? No, case management is a Children's Choice Waiver service.  In fact, DHH has raised the cap from $7,500 to $15,000 in order to address this concern.  The case management agency is responsible for development of the comprehensive plan of care and assuring the services your child needs are delivered.  But, DHH will continue to seek ways to make the case management requirement more flexible.

15. Are there any other services under Children's Choice that families/Children are required to take or use in a specific amount of funding? No.  There are no other "required" services under Children's Choice.

16. How do I choose a case management agency? Case management agencies are selected from a "freedom of choice" list. This list will be sent after a family has accepted Children's Choice.

17. Can families who accept Children's Choice for their child receive the funding directly, or through a fiscal intermediary, so they can recruit, hire or fire the in-home supporters?  If not, why not and are there plans to include such an option?
This is not available at this time and would require an amendment approved by Centers for Medicare and Medicaid Services (CMS) to the Children's Choice Waiver.

18. How long does it take to get services once my child has been determined to be eligible?  The process works as follows:

1) The family accepts Children's Choice Services
2) A case manager is chosen and development of a Comprehensive Plan of Care 
    (CPOC) begins
3) The child is determined eligible for the Children's Choice Waiver; and
4) The CPOC is approved.
5) The case manager then begins to implement the CPOC and arrange other
     necessary services.

19. How often is our family required to get an eligibility determination?
Re-certification is required annually, and the CPOC is renewed annually as well.

20. I've been told that the service limit cap of $15,000 per year represents an increase.  Is this true? Yes.  The Department of Health and Hospitals (DHH) raised the yearly cap from $7,500 to $15,000 per plan-of-care-year.  This was done in response to concerns by parents that $7,500 was insufficient to meet the needs of their children.  Parents and advocates have expressed great support for this increased limit.

21. If I have concerns about my service provider(s) or case manager, who should I call? Call the  toll-free help line at 1-800-660-0488.

22.  If I accept Children's Choice, how will that affect the services I am receiving from other programs? Regarding state funded programs, it is a case-by-case decision as to whether there would be an effect.

23. Can a family "stockpile" time for family supports such as respite or personal care assistance (PCA) for use during holidays or summer vacation?
The number of hours are based on each individual's needs based on the CPOC.  The CPOC should be flexible to meet the individual's needs, and if one's needs change, the CPOC can change, thus allowing the individual flexibility.

24.  Will accepting Children's Choice affect my child's Supplemental Security Income (SSI) or the Medicaid services he receives now? This acceptance should have no effect on other Medicaid state plan services.  SSI would need to be contacted to see what effect it would have, as SSI is an individual determination.

25.  What is considered "direct care"? Direct care can be services and supports provided in a direct manner to the individual.

"Inclusion recognizes every individual's right to be treated equally, and to be accorded the same services and opportunities as everyone else. In a school setting, full inclusion involves educating all children in regular classrooms all of the time, regardless of the degree or severity of a disability. Effective inclusion programs take place in conjunction with a planned system of training and supports. Such programs usually involve the collaboration of a multidisciplinary team which includes regular and special educators (or other personnel) as well as family members and peers."

Many uses of technology can support the successful inclusion of students with a disability in the classroom. Adaptive technologies and equipment enable students with disabilities to participate more directly in classroom activity for example all students can benefit from accessing computer mediated instructions. Students can incorporate technology in developing their vocational technical skills for future employment and independent living.

Planning for inclusion may involve a wide variety of tools and techniques. The following are some techniques frequently mentioned in the literature.

Circle of Friends (also called Circle of Support) is a technique used to enlist the involvement and commitment of peers in developing and supporting effective inclusion.

COACHis an assessment and planning tool designed to help educators identify family-centered priorities for their students, define the educational program components, and address these components in an inclusive setting.

MAPS (Making Action Plans) is a creative tool which inclusion facilitators can use to help individuals, organizations, and families move into the future.

PATH(Planning Alternative Tomorrows with Hope) is a creative tool which inclusion facilitators can use to develop long and short range planning by encouraging people to think "backwards."