by Guinevere

Who decides if a student with visual impairment needs services, and within that decision, precisely what services?

What is a teacher to do if the eye report (be it on the form we send the doctor, or in a letter the ophthalmologist chooses to send instead) makes the statement that not only are services needed, but that they should include specific curriculum (eg. braille) and/or specific methods and materials (which the parent has heard of, and wants, and asks the doctor to recommend)?

WHO DOES WHAT?

Ophthalmologists provide a medical diagnosis and prognosis. The Team (including the Parent), school personnel (itinerant, resource, classroom teachers, and other specialists as needed) assess the child's progress in the general curriculum (as IDEA requires), perform formal and informal assessment of visual function, academics, intellectual, adaptive (both parent report and teacher information), speech/language, etc. All of the information, including the eye report, must be considered in designing the Individual Education Plan.

First, the issue of role definition between the physician and school personnel. Some good ways of handling the issue have been presented on AERNET. Individual communication with the doctor can work in some cases. In other cases, not. Perhaps the parent fears that the service they want will not be provided and asks the doctor to include their desired recommendations in the eye report. The doctor may do so, and the parent sees this as a "prescription" in the sense of a prescription for medication, which the pharmacist is required to fill exactly as written. This may be the physician's belief as well.

Some physicians underestimate (perhaps deny) the ability of the teacher of the visually impaired to understand the eye report. As a profession, we must be better communicators about the content of our training in this regard.

PUBLIC RELATIONS: Key to maintaining good ones

Teachers should keep in mind that the goal is to handle such a situation without antagonizing the parent and/or the physician. The long term consequences of such a fight can be severe. The teacher should resist the impulse to spit out snappy comebacks like: "I don't tell you how to do eye surgery. Don't tell me what and how to teach!" This may be the first thing that comes to mind, and no doubt it's the truth, but bite your tongue.

Carefully explain that there are many issues which need to be considered before determining whether and what services are appropriate, and that such decisions must (as sound practice, and as a matter of law) be made by the Team. When challenged to defend that statement, further explain that the Team includes the PARENT, as well as the Teacher (of the visually impaired), the Teacher (in the child's classroom, an Administrator (of the child's school), and any other personnel who might be involved in the Multidisciplinary Assessment and services for the child (occupational, physical and/or speech and language therapies, school psychologist). The ophthalmologist's report is one of the many pieces of information which must be considered as the whole child is assessed for abilities and limitations which need to be addressed.

Second, the issue of parents who are "high risk." Special education administrators use the term to describe parents who are likely to sue. Of those who are "high risk," there are two general categories:

a. parents who are well informed and realistic, and are in a district which tries to get away with providing inadequate services because of money, or because the "teacher's philosophy" is that this or that kind of service pattern, or this or that type of instruction, is not needed.

If the issue is money, and the teacher sees the necessity of the service, a high risk parent can be the teacher's best friend. Such a parent will take the issue to the next level, and rather than go to the legal expenses involved in due process, the district is likely to capitulate because so doing will actually cost less. Tact and diplomacy with your administrator in expressing your recommendations is of utmost importance here; you do not want to be seen as a rabble rouser. You do want to keep your job.

Nevertheless, the law (IDEA) requires you to not only hand the parent the booklet describing the student's and parent's legal rights, but to explain those rights clearly, and answer questions.

If the issue is "teacher philosophy," then the parent must be the child's best friend, get sound information from credible sources, and present that information. If the teacher is unresponsive, then the parent must appeal to administration. If you or one of your colleagues is one of those teachers who (you name it: doesn't believe in braille for any but the absolutely totally blind; believes only in self-contained classrooms and has been unwillingly assigned to an itinerant caseload and has an agenda of sabotaging it ... both are real situations this writer has heard of) then watch out! The profession has passed you by and you either need to get current or get out, for the sake of the students and yourself. The parent has a legitimate beef, and plenty of support available.

b. parents who are clearly "whacked out" on their grief, who deny some aspects of the child's disability, and have been sold a bill of goods by (you name it: certain consumer organizations, attorneys, parent "advocates," etc).

They are angry, they have been whipped into a frenzy, and ***by damn*** they are going to make someone pay, literally and figuratively. This type of high risk parent is not necessarily going to be the teacher's (or anyone's) best friend, at least until the right kind of help (maybe grief therapy, and "tincture of time") is obtained.

Good practice and your district will both tell that your job is to do your best not only to serve the child, but to indemnify the district as well. This may look like a conflict of interest, but it is not. It is what you must do to reduce the risk to yourself and to the district. This parent needs rights explained too. This parent needs to think of you as best friend and advocate. This parent may make it impossible, or at least very difficult to do so. But try you must.

And just in case it is impossible, DOCUMENT, DOCUMENT, DOCUMENT every contact, whether in person or on the phone. You can bet that a litigious parent will be documenting, so you'd better do so as well.

Yes, it is time consuming, and adds to the already overburdening responsibilities you already have. (Do this even when parents don't at first seem to be high risk. A perfectly reasonable parent can turn into a high risk one practically overnight.)

Perhaps an organization like AER can help by writing a booklet for both parents and physicians that explains best practice in the decision making process, in language which will make it clear to all. Such a document could go a long way in preventing the kinds of conflicts being reported on AERNET.

Maybe the booklet should weigh about an ounce, to point up the fact that an ounce of prevention is worth ... well you know the rest of it.

 The faire Guinevere