Reforming funding for school-based special education - at the point of a gun

Nearly three years ago I offered to work for NYS for free to help tackle the problems of Medicaid fraud for special education services (see http://abctherapeutics.blogspot.com/2006/06/new-york-states-medicaid-problem-in.html). The system needs reform badly - and although I never expected to be asked to serve I was actually quite sincere in my concern and desire to effect some improvement in the system.

As I predicted back then, there would eventually come a day of reckoning to pay for the fraud and abuse - and it seems that we are at that day. In today's Albany Times Union, reporter James M. Odato informs us that the New York State Education Department is withholding Medicaid payments to school districts in accordance with a settlement agreement that has NY State paying out hundreds of millions of dollars back to the federal government.

Also as predicted, this leaves school districts in quite a pickle - because they are still mandated to provide these services by law - and now the burden for payment may fall to local districts - which equates to higher taxes for all.

I have always viewed opportunities and threats the same - both require action. I think that this particular situation provides an opportunity for districts to begin looking at their models of service provision and see how to provide services more efficiently. That includes setting appropriate entrance and exit criteria for related services, adopting evidence-based or RTI-type models for educational intervention, and improving team building to ensure that services are reinforced in a transdisciplinary way throughout the curriculum. All of these strategies would help improve the efficiency and also the quality of special education services.

Professionals also have new opportunities to improve focus on school-home carryover. Parent involvement is critical for positive educational outcomes and may be the largest underutilized resource in the special education equation.

Because I am inherently cynical I understand fully how someone might think that I am speaking code for decreasing related services and abdicating responsibility to parents - but I am not. I am talking about an open dialogue about educational best practices and establishing responsible and defensible criteria points for intervention. We have had too many years of poor oversight, lack of accountability, and variable interpretation of special education regulations.

Reform is hard but reform can be good when it is done correctly. Reform should not be driven by some perceived benefit of political expediency or in satisfaction of legal settlements. Our special education system and its funding mechanism is broken and now we have a real chance to improve.

Will we make the most of this opportunity?

Comments

Your Therapy Source Inc said…
The key phrase in your post is lack of accountability. Related service providers frequently do not have a on site supervisor which results in abuses of the system.

Parents frequently do not want services to discontinue. Therapy services are non pharmacological and non invasive. In addition, they offer hope for change.

It is difficult to change the way services are provided when very few people feel that it needs to change.

We are just finishing up a poll on discontinuing OT/PT services. So far the results indicate that the majority of therapists find it difficult to discontinue therapy services. That is another important statement that you made - entrance and exit criteria. I think the exit criteria is more important than the entrance. If goals are met or skills have plateaued for a certain amount of time, services should be discontinued.
10:42 PM
Post a Comment

Popular posts from this blog

On retained primitive reflexes

Each year I receive several emails from colleagues about 'retained primitive reflexes.'  I am also seeing an increased number of reports from local 'health care' providers who are documenting these alleged problems so I thought I would write a summary of my opinion on this topic.   Predatory 'health care' providers including some OTs, PTs, chiropractors, and behavioral optometrists are creating a new 'market' for treating this alleged 'problem.'  Parents should be very wary of these practitioners and other professionals should challenge these practices whenever they are seen. The following is the kind of information that causes concern and was provided to me by a colleague as a sample from a student's IEP: The student continues to demonstrate the following retained primitive reflexes that at times interfere with his ability to demonstrate appropriate adaptive responses: Fear Paralysis Reflex, Moro Reflex, Palmer Reflex, Tonic Labyri...
Read more

Deconstructing the myth of clothing sensitivity as a 'sensory processing disorder'

Please note first that there is no formally recognized clinical designation of  'sensory processing disorder.'   It is a term constructed by occupational therapists that has not been formally recognized by the larger medical community. In our clinic we receive many referrals from local pediatricians when parents have concerns about children being overly sensitive to their clothing.  Most often the children referred are from four to seven years old and the families are severely disrupted by the children's behaviors and responses to clothing issues.  Commonly, children will have severely constricted tolerance for certain outfits, want to wear the same clothes repeatedly, complain that clothing is itchy/scratch/bumpy/wiggly/ouchie, and this all leads to disruption of daily dressing routines.  There is no doubt that the behavioral concerns are very real. The pediatricians tend to be appropriately conservative and provide families with good behavioral manage...
Read more

Occupational therapy education: How to navigate in a Perfect Storm

Image
Please click on and read all of the links - they include critical information that is required for this analysis.   A little over four years ago I stated that there are too many occupational therapy educational programs in New York State .  At the NYSOTA conference legislative information session in 2023 I stood up and suggested that we should all stop taking jobs at these institutions that were seeking to develop new programs.  I thought that if we did not take those jobs that the problem would be solved.  That was not realistic or correct, even if the intention was good. Well karma tends to strike when you make public pronouncements, so I thought I should expand on my perspectives on this topic. At current count there are still ~22 occupational therapy programs and ~11 occupational therapy assistant programs in NY.  Most of the programs are delivered at the master's level.  There are a very small number of entry level doctoral programs, but some of t...
Read more