Monday, May 17, 2010

For Educators - Letters to Follow-up with Outside Practitioners

I have been having many trainings and follow-up conversations with folks regarding my previous post on Mental Health practitioners. My most common request from educators is on the specifics of how I follow-up with letters.
 You know… THOSE letters.
The ones that start “To Whom It May Concern:” or are 3 sentences on a prescription pad.

I always follow-up with every letter with a request for a HIPAA release and a letter similar to the exemplars below.

Note: For parents and outside practitioners: Feel free to provide this information up-front to make things run smoother.

The most common scenarios are:

 -  Requests for home teaching (AKA Home/Hospital) or Independent Study.

 - The "straight-A-honors-student-insisting-on-504-for-SATs" boom that we get the same time every year.
(I also have some good resources from the Federal Education Office of Civil Rights mandating that we do NOT automatically accept clinician's diagnosis for 504's. See FAQ's 23-28 at http://www2.ed.gov/about/offices/list/ocr/504faq.html).

- Clinically specific information that may or may not have educational implications.
(I just had a meeting where folks wanted to argue between one clinician's diagnosis of Cyclothymic Disorder and another's of Bipolar II. Really? What are the educational ramifications of this argument in a school conference?)

Here are my main points in my follow-up:

1 – Any relevant outside information regarding a disability requires follow-up and consideration under special education law and Section 504 – especially as it related to child-find, parental input, and consideration of all available data.

2 – Per my previous post, my teams need data and information – not just opinions. I do not think that there is anyone immune from a mandate to use evidence-based practices or data-driven decision-making. Therefore, we all need evidence and data.

3 – Some folks like to step out of their scope of practice and tell us how to educate. We appreciate your input, but let’s collaborate within our respective roles and start with the facts before we form opinions.


The response that I receive is usually one of the following:

1 - I get some good information that is practical and useful. Good collaboration usually means less effort and better results.

 2 - No practitioner response. We then document three attempts and requests in written format and give the letter appropriate weight based on what objective data is documented.

3 – The letter’s author will often call and yell at us for daring to not immediately comply with their demands. My staff is instructed to listen and then professionally ask, "Is this a refusal to provide or when should I expect this info?"

4 – Parent refuses to sign the HIPAA release. Sometimes, parents have had a prior bad experience regarding confidential information. I can usually show them the letter for the information that I am requesting and get provisional approval to access this specific information-only. (See Below) Outright refusals often happen when I suspect a manipulation to “game” a certain outcome. We document parent refusal and give the letter minimal weight.

SAMPLES

Scenario 1 – Request for home teaching on a student refusing to come to school for mental health reasons. Letter states that student should be on home-teaching, but it does not give solid rationale or evidence as to why.
School Refusal is a tough-one.
If you face this, consider reading:


I am writing to follow-up on the request for a Home Teaching placement for this student that was initiated, in part, by documentation from you provided by STUDENT’s father. I have enclosed a current HIPAA release and my recent conference summary with Mr. SAMPLE. So that the IEP Team may consider your recommendation, please submit documentation that includes the following:

  • Specific Diagnoses.
  • Estimated duration of home teaching’s necessity. We understand that this is an estimate that will likely change.
  • Rationale on how you recommended the educational placement of Home Teaching over all other educational and therapeutic placements available through AVUHSD.
  • Any available assessment data that will assist the IEP Team, that will include both school and clinical staff, in planning a multi-modal treatment collaboration to include a transition back to campus using a systematic desensitization protocol.

I appreciate your assistance in this matter. If you have any further questions or concerns, please feel free to contact me.

Sincerely,



SCENARIO #2 – 3 Sentence “To Whom It May Concern Letter” demanding a 504 for a student being seen by a private therapist for depression who, until the receipt of this letter, staff have had no knowledge or evidence of an educational impairment.


I am writing to follow-up on a Section 504 Plan request for this student that was initiated, in part, by documentation from you provided by STUDENT’s father. I have enclosed a current HIPAA release and my recent conference summary with Mr. SAMPLE. So that the 504 Committee may consider your recommendation., please submit documentation that includes the following:

  • Specific Diagnoses by which you believe that the student has a qualifying impairment and assessment information that led you to this conclusion.
  • The major life activities that you assessed as being substantially limited and assessment information that lead you to this conclusion.
  • Any available objective assessment data that will assist the 504 Committee in making final consideration of eligibility as having an impairment that substantially limits one or more major life activity, and, if eligible, will assist in the determination of services and accommodations.

I appreciate your assistance in this matter. If you have any further questions or concerns, please feel free to contact me.

Sincerely,



Again, see the Federal Education Office of Civil Rights mandates that we do NOT automatically accept clinician's diagnosis for 504's. See FAQ's 23-28 at http://www2.ed.gov/about/offices/list/ocr/504faq.html.


My deepest gratitude to all of my audiences that have been spending half- to full-days listening to me talk.

I hope this helps!




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