Wednesday, April 29, 2009

Doctors, lawyers team up to get special ed services for students

From The Cleveland Plain-Dealer. In the picture, Barbara Leadbetter and her daughter, Teela Kelly, 12, read outside their home. Leadbetter is among many parents who have asked Legal Aid for help in getting special-education services from the Cleveland schools.

CLEVELAND — Doctors and lawyers are double-teaming the Cleveland schools' special-education office.

MetroHealth Medical Center pediatricians who suspect that their low-income patients suffer from learning disabilities are referring families to Legal Aid lawyers with offices in the hospital and three neighborhood health centers. The lawyers then pressure the school district to provide what can be costly services.

The collaboration, known as the Community Advocacy Program, began in 2002 but gained momentum as it added sites and attorneys. The advocacy program took on 117 special-education and other school cases last year, up from 37 in 2006. Up to three-fourths of the cases involved the Cleveland schools.

"It's jumped tremendously," said Robert Walsh, the Cleveland district's executive director of special education.

Walsh said he added an employee this school year just to help with the volume. Demand also has swamped the three Legal Aid education lawyers, forcing two to temporarily stop taking new cases early this year.

Cleveland's alliance, underwritten by the United Way, foundations and law firms, was one of the first in the country, said Ellen Lawton, executive director of the Boston-based National Center for Medical-Legal Partnerships. Such cooperation now exists in 80 cities, Lawton said.

The Community Advocacy Program helps poor people of all ages with a variety of legal issues that pile up and make it hard to lead healthy, productive lives. Special education is probably the No. 1 concern, but lawyers also handle tasks such as appealing denial of Medicaid eligibility, and hounding landlords to clean up mold and lead paint.

Legal Aid also takes on suburban and charter schools, but the Cleveland district, because of its size and poverty, generates most of the partnership's special-education cases.

The number of district students in special education has remained steady, but the percentage has climbed as other children abandoned the city's public schools. Nearly one in five Cleveland students gets customized attention for all or part of the day, compared with less than 15 percent statewide.

MetroHealth's pediatricians watch for signs of disability during checkups. If doctors detect problems in intellectual development or behavior, they write referrals for legal counsel.

"When a child comes to see the doctor, the first question is, 'How are things going at school?' " said Legal Aid lawyer Mallory Curran, who keeps hours two days a week on a MetroHealth pediatrics floor. "The medical doctors are such good screeners."

Curran proposed the program after learning of a similar setup in Boston. MetroHealth pediatrician Robert Needlman said doctors welcomed assistance with legal issues for which they have neither time nor expertise.

The school bureaucracy can intimidate parents who often have their own learning disabilities, Needlman said. He said parents may simply go along when schools write off their sons and daughters as "bad kids."

"If the child had cancer, there'd be all sorts of help," Needlman said. "If your child has dyslexia or ADHD [attention-deficit hyperactivity disorder] or any behavior-type problem, you're likely to get blame or you're likely to blame yourself."

Students whose emotional problems go undiagnosed may face repeated suspension from school, said Vanessa Coterel, a Legal Aid lawyer who works with doctors at Nationwide Children's Hospital in Columbus. She knows of parents who lost jobs, and ultimately homes, because they had to constantly leave work to pick up children in trouble.

Curran said Legal Aid and the district have typically settled cases, though a few have gone to mediation.

Solutions vary. In some cases, the district agrees to have speech pathologists work with children who understand questions but can't quickly put their responses into words. At other times, officials might provide busing for mentally retarded students who cannot walk safely to school on their own.

Curran said the district special-education operation is capable but often acts slowly or resists changing students' individual plans.

The district is not unique in that regard. In a survey of parents taken last year, a statewide medical-legal task force found that more than 25 percent of children had waited longer than six months for services to start and more than one in six waited longer than a year.

Barbara Leadbetter turned to Legal Aid more than four years ago. She said her daughter, Teela Kelly, then 7, suffered from seizures, ADHD and speech problems, but except for an hour of tutoring, she remained in regular classes at her Cleveland elementary school all day.

After appealing unsuccessfully to the principal for three or four months, Leadbetter turned to Legal Aid. Curran arranged a meeting with district officials and got Teela into smaller disabled-only classes.

"They weren't listening to me," Leadbetter said. "Just her presence alone changed everything."

Walsh said the district bases its decisions on what's best for each student, but special education has become increasingly expensive for all school systems. Cleveland spent $23,100 per special-education student last year, about $10,000 more than the average for all students.

The district has about 600 students in private day treatment or residential programs that can cost up to $80,000 a year for one child. Walsh and Curran said, if possible, they try to keep children in city schools, a choice encouraged by federal and state law.
Walsh blamed some of the disputes with families on miscommunication. For example, he said, administrators and teachers might mistakenly tell parents that their schools cannot provide certain services.

"Sometimes, as a district, we shoot ourselves in the foot," Walsh said. "We're educating our staff as we go along."