Story by Liza Long, Photography by Pete Grady
From the Greenbelt Magazine
APRAIS coalition applauds the introduction of the Keeping All Students Safe Act by Sen. Harkin
The Alliance to Prevent Restraint, Aversive Interventions and Seclusion, known as APRAIS, applauds the much sought-after introduction of the Keeping All Students Safe Act by U.S. Senator Harkin, (D-Iowa) and co-sponsored by Senator Murphy (D-Conn.). If passed, the legislation will provide federal protections for students by prohibiting abusive seclusion and restraint use in schools. Representatives George Miller (D-Calif.) and Gregg Harper (R-Miss.) introduced a similar bill in the House last year (HR 1893).
APRAIS, a 30-member coalition that has advocated for a federal baseline of protections for years, believes the long overdue legislation will ensure the prevention of practices that cause physical and emotional harm to students with and without disabilities. These practices have resulted in the serious injury, emotional trauma and death of hundreds of children nationwide.
“The lack of protections for students limiting the use of restraint and seclusion has proven to be a disastrous missing component of our national education policy for children and parents. If passed, the Keeping all Students Safe Act will align federal education policy with all other federal policy related to human services and for the nation’s youngest, most vulnerable citizens,” said Barb Trader, Executive Director of TASH, which founded the APRAIS coalition. “The members of the APRAIS coalition and TASH are grateful to Senators Harkin and Murphy for their leadership on this issue, and urge swift passage of this legislation that fully protects each student’s right to be safe at school.”
The introduction of the bill was preceded by the release of a report by the Government Accountability Office (GAO) on the use of restraint and seclusion in public schools. Instances of restraint and seclusion use in 10 states are highlighted, describing the impact on students and families. It reveals that parents of students who are restrained or secluded are not notified and highlights difficulties they face, once aware, to end abusive use of these techniques by school staff. This follows a 2009 report, also by the GAO, which drew national attention to this issue. Both reports found abusive practices were occurring in schools throughout the U.S. Both reports also acknowledge that no federal laws exist restricting restraint and seclusion in schools, and state laws vary widely if they exist at all.
The APRAIS coalition has worked with Sen. Harkin and others in Washington for a number of years urging for adequate protection from and reporting of restraint and seclusion instances in schools. Representatives George Miller and Cathy McMorris-Rodgers (R-Wash.) first introduced the Preventing Harmful Restraint and Seclusion in Schools Act (HR 4247) which passed the House with bipartisan support in 2010. Since that time, numerous reports, national data collection by the Department of Education Office of Civil Rights, and news reports have highlighted alarmingly frequent use of restraint and seclusion in public schools. You can learn more about the APRAIS coalition, TASH and nationwide efforts to prevent restraint and seclusion by visiting www.tash.org/aprais and http://stophurtingkids.com.
Additionally, please take a look at the US International Council on Disabilities information on Myths and Facts:
Schools have long understood that they must serve children with disabilities in the LRE. But they must also think about LRE when making work placements, according to OSEP.
The agency's thoughts were conveyed in a letter to three Wisconsin disability groups that had sought the agency's input in December.
"Under the IDEA, a segregated employment program may be an appropriate work placement for a particular student if determined appropriate by that student's IEP Team based on the LRE requirements and the specific individualized needs of that student," it said in Letter to Spitzer-Resnick, Swedeen, and Pugh, 112 LRP 32664 (OSEP 06/22/12). "That is, the IDEA does not prohibit segregated employment, but the LRE provisions would apply equally to the employment portion of the student's program and placement."
That may not seem earth-shaking, according to Lisa Pugh, public policy coordinator for the Disability Policy Partnership, a collaboration between Disability Rights Wisconsin, the Wisconsin Board for People with Developmental Disabilities, and the University Center for Excellence in Developmental Disabilities at the University of Wisconsin.
But it may help change the default job placement when schools are trying to help a child with a disability get some work experience, she said.
The letter "allows us to further educate parents, . . . transition teams, and school districts," she said. "It starts a conversation to say, there should be more than one work placement that is offered to a student in a district."
Hoping for more monitoring
LRE was not the only issue that OSEP addressed in its letter. In response to the questions posed by the disability groups, it also said:
· Work placements must be included in an IEP "if an IEP team determines that work placement is an appropriate transition service."
· A work placement that is listed in an IEP "becomes part of the student's educational program and part of the provision of FAPE to the student." Thus, OSEP said, "if a public agency is proposing or refusing to initiate or change a work placement that is part of a child's transition services, the public agency would be required to provide the parent with written notice, as described above, a reasonable time before the proposed placement is initiated or changed."
· The district must provide supplementary aids and services, if needed, to "enable the student to participate with other students with disabilities and nondisabled students in the work placement described in the IEP."
OSEP also addressed the issue of monitoring work placements for compliance with the principles of LRE.
"If there is evidence that a public agency makes placements that are inconsistent with [the LRE requirements at 34 CFR 300.114 ], the SEA must: (1) review the public agency's justification for its actions; and (2) assist in planning and implementing any necessary corrective action," it said.
That's important, Pugh said.
If, for example, all the transition-age students with disabilities in a given district were found to be working in segregated settings, "we're going to push for some kind of monitoring and hope that it raises red flags," she said.
Parsing the letter
The state does have a role in monitoring work placements, according to Patrick Gasper, a spokesman for the Department of Public Instruction.
"Regarding the letter from OSEP, the DPI agrees with its content (that transition services must be based on appropriate measurable post-secondary goals and that it is not appropriate to place a student automatically in a segregated community rehabilitation center)," he said in an email. "It confirms that the SEA has a responsibility to monitor an LEA if evidence exists that the LEA makes placements that are inconsistent with the provisions of IDEA."
He drew a slightly different conclusion, however, about the meaning of the letter when it comes to whether work placements are required to be listed in an IEP.
"We also believe that the letter affirms our position that a work placement does not have to be a part of an IEP," he said.
Gasper's statement may be a reference to the fact that a given student may not have a work placement, as indicated in the letter from OSEP.
"Work placement can be an appropriate transition service, depending on the individual needs of a student," it said, "but is not a required component of all IEPs that address transition services."
KHN Staff Writer
JUN 28, 2012
The U.S. Supreme Court today upheld the landmark federal health law, affirming its mandate that nearly all Americans carry coverage and retaining sweeping changes to the health industry.
Chief Justice John Roberts Jr. joined the liberals on the court in upholding the mandate, deciding the penalty for not carrying insurance is a tax and therefore falls within Congress’ taxing power. But the justices voted to set limits on the law’s expansion of Medicaid, the federal state program for the poor, leaving up to states to decide whether to participate.
While the decision bolsters the Obama administration’s signature legislation, it complicates efforts to create nearly universal health coverage if states opt out of the Medicaid expansion. Many Republican governors had hoped the court would strike the Medicaid expansion.
The decision leaves intact the remainder of the 2,700 page law, which requires insurers to accept all customers regardless of their health status, provides tax credits to those who need help to buy coverage, fines some employers who don’t offer insurance and provides billions to expand Medicaid to include many people not currently covered in many states. Those provisions go into effect in 2014.
"I'm disappointed and shocked that Justice Roberts led the charge to uphold the constitutionality of the mandate and called it a tax," said Bill McCollum, who filed the first state lawsuit against the act when he was Florida's attorney general. "I certainly don't think it's a tax. It's a sad day for the American people."
Long in the making – at least five previous presidents tried and failed to pass legislation with similar aims – the law remains controversial two years after its passage.
While the ruling removes some legal uncertainties, a slew of political and technical challenges remain. The law and today’s decision are sure to feature prominently in the run-up to the November elections and the law’s fate could well hinge on the outcome. If Democrats retain the presidency and control of the Senate, implementation will likely move forward. If Republicans sweep one or both, efforts to repeal or defund are sure to gain steam. Presumptive GOP presidential nominee Mitt Romney has vowed to repeal the law if elected.
"The election is two or three times the importance of court decision," said Robert Laszewski, a consultant to the industry and former insurance executive.
While the majority opinion upheld the law’s requirement that nearly all Americans carry health coverage or pay a penalty, polls show the mandate remains hugely unpopular. Without that provision, however, most experts say that young and healthy people would forego insurance, leaving primarily sick and older people needing expensive medical care in the pool, and driving up the cost of premiums for everyone. The issue is likely to become fodder for the campaign trail.
Democrats "will try to use this to segue from 'it's legal,' to 'it's great, even the court thinks so'," said David Merritt, a senior advisor with Leavitt Partners, a health consulting firm founded by former Bush administration cabinet member Michael Leavitt.
Republicans, Merritt said, "will use it to try to raise the stakes of the election: 'This is the last chance we have to repeal this thing.'"
Florida's McCollum predicted the law's survival would energize attempts to defeat Obama in November elections and repeal it.
"If the president is re-elected, then this law will go forward," he said. "If he isn't, then I think there will be a different outcome in the health care arena."
Impact Of Medicaid Ruling
State politics, meanwhile, will come into play on the ruling on the Medicaid expansion. The ruling gives states the option not to expand eligibility without losing funding for their existing program. They would, however, lose billions in additional federal funding that would have covered newly eligible residents up to 133 percent of the federal poverty level, or about $30,000 for a family of four. Today, about 60 million people are enrolled in the program.
Sara Rosenbaum, health policy professor at George Washington University, said she expects "the overwhelming number of states" to adopt the Medicaid expansion.
"The pressure to participate will be enormous from health care providers and communities," she said. "The majority of states will not want to have its poorest residents without coverage.”
Signed into law March 23, 2010, after being passed without a single Republican vote, the health care legislation was promptly challenged, with 27 states filing or joining lawsuits challenging its constitutionality. Republicans argued the law was an overreach of federal authority and that its new taxes and fees would hurt the economy. Democrats said that slowing health care spending with provisions such as a powerful advisory board to curb Medicare costs and the so-called "Cadillac tax" on high-cost insurance benefits, would boost the economy. At the same time, the law would provide relief to millions who could not afford or qualify for insurance coverage.
The Congressional Budget Office, a nonpartisan government agency, estimated it would add up to 33 million people to the insurance rolls by 2016. Still, about 26 million people are expected to remain uninsured, many of them undocumented immigrants.
The law makes few changes for people who get their coverage through their jobs, which is the main way most insured people currently receive insurance.
Most employers who provide coverage say they will not drop it in 2014, even though the $2,000 to $3,000 in penalties on those who don’t offer affordable coverage is less than what many pay for insurance.
Still, the CBO estimates that about 3 million to 5 million people who otherwise would have had employer coverage will lose it. Some of those workers will be eligible to buy insurance through new state marketplaces, some with subsidies to help them pay for it.
Implementing the law is estimated to cost about $1 trillion over nine years, much of that for the insurance subsidies and expansion of Medicaid, according to the CBO. That is slated to be paid for through savings wrung from Medicare, along with new taxes on industry and high income earners.
Gearing Up For Deadlines
The high court's decision comes a year and a half before January 2014, when some of the most significant changes called for in the law take effect. Those include the launch of new state-based marketplaces where consumers will shop for coverage, the fining of employers with 50 or more workers who fail to provide affordable coverage and the expansion of Medicaid.
But whether the federal government and the states will be able to meet the deadlines is far from certain. An estimated 17 states were awaiting today’s decision – and in some cases, the outcome of the November elections -- before moving ahead to set up the online marketplaces where consumers will shop for coverage and check eligibility for tax credits to help them buy.
To date, only 14, including California, Colorado and West Virginia, as well as the District of Columbia, have authorized creation of the marketplaces.
States that waited for the court decision may find they have run out of time since they must submit a blueprint for the marketplaces by Nov 16.
"We could have 20 or 25 states not ready," said Laszewski.
In addition, many must resolve a host of technical challenges, including revamping aging computer systems, to prepare for increased Medicaid enrollment – and to link with federal agencies, such as the IRS, to help determine applicants’ eligibility for Medicaid or tax subsidies.
Today’s decision "doesn’t resolve any of the technical aspects the states are facing," said Joseph Antos, a health policy scholar at the conservative American Enterprise Institute.
In addition, insurers, employers and industry leaders say they don’t have all the guidelines they need from federal regulators. Federal officials, meanwhile, are navigating technical and political issues surrounding the marketplaces.
The law says the federal government will run the exchanges in states that are unable or unwilling to do so. Many policy experts say delays by governors reluctant to implement the law, coupled with technical difficulties, means that the federal government may be overseeing all or part of the vast majority of state-based marketplaces.
"The feds still have so much to do. So there’s a sigh of relief [that the court ruling was favorable] and things are moving ahead, but they’re also terrified that things are moving ahead," said Merritt at Leavitt Partners.
Health Providers Already Changing
The private sector, in contrast, has already taken significant steps.
Doctors, hospitals and insurers have begun changing the way they do business as they prepare for an influx of new customers and federal incentives aimed at slowing health care spending by rewarding increased coordination among medical providers. Some are creating so-called "medical homes," where care is coordinated and financial savings are shared among doctors, hospitals and other providers.
"The train is really well out of the station at this point," Sara Collins, a vice president at the Commonwealth Fund, a health foundation in New York City told Kaiser Health News earlier this month. "Insurance carriers are already functioning in this new world that they’re living in."
The American public, however, remains split on the law. A New York Times/CBS poll released in early June showed that two-thirds of Americans wanted the court to strike down at least part of the law, while 24 percent wanted the entire legislation kept in place. Most, however, knew little about the law’s provisions.
The court decision "is not necessarily going to make the law more popular," said Robert Blendon, Harvard professor and polling expert. "It’s almost impossible to move people’s views one way or the other."
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On May 15, 2012 the U.S. Department of Education announced the release of a 40 page resource document on seclusion and restraints. U.S. Secretary of Education Arne Duncan, Special Assistant to the President for Disability Policy Kareem Dale, and U.S. Department of Education Assistant Secretary for Planning, Evaluation, & Policy Development Carmel Martin discussed the importance of this resource and corresponding principles.
The publication outlines principles for educators, parents and other stakeholders to consider when developing or refining policies and procedures to support positive behavioral interventions and avoid the use of restraint and seclusion. The resource is applicable to all students, not just those with disabilities.
Please refer to the following links for more information:
Restraint and Seclusion Resource Document: http://www2.ed.gov/policy/seclusion/index.html
This week, March 18-24, marks the 50th anniversary of National Poison Prevention Week.
For the first time in decades, poisoning surpasses motor vehicle accidents as the number one cause of injury deaths. Ninety percent of poisoning deaths are caused by drugs, including an increasing proportion of prescription painkillers.
The HRSA-funded Poison Help line, which connects callers to their local poison control centers, is a free and confidential service for everyone—kids, adults, seniors and even healthcare providers. Nurses, pharmacists, doctors and other specially trained poison experts provide consultations and treatment recommendations 24 hours a day, 7 days a week, 365 days a year, in over 150 languages and for the hearing impaired.
When it comes to poisoning prevention, don't guess, be sure. Remember this number -- Poison Help (800-222-1222). To find out more about HRSA's Poison Control Program, visit www.poisonhelp.hrsa.gov
February, 2012: Download a Printable Version here.
Feature Story: Keeping Families at the Center of Health Care
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January 19, 2012, the U.S. Department of Education’s Office for Civil Rights (OCR) released new guidance regarding the Americans with Disabilities Act Amendments Act’s impact on public elementary and secondary education programs. The Dear Colleague Letter and Questions and Answers document discuss how Section 504 and the ADAAA define disability and the obligation of school districts to evaluate students for disability, provide a free appropriate public education to students with disabilities, and provide procedural safeguards for identification, evaluation, and educational placement. See links below for further information and resources.January 19th, 2012,
2012 Summer Transportation Internship Program for Diverse Groups (STIPDG) Deadline: December 31, 2011
We are reaching out the disability community to announce the United States Department of Transportation 2012 Summer Transportation Internship Program for Diverse Groups (STIPDG) program is open. The deadline is December 31, 2011.
The internship is a paid opportunity and will provide a life changing experience.
Thanks to the Sara Lee TICKETS Fore CHARITY™ program, 100% of every ticket sold goes directly to a local participating charity of your choice. And that charity receives its proceeds the very next month!
A major component of the Albertsons Boise Open presented by Kraft's charitable efforts is the Sara Lee TICKETS Fore CHARITY program, and we encourage all local non-profits to be a part of this incredible initiative! Thanks to the program, 100% of proceeds from all tournament ticket sales goes directly to participating charities in the Treasure Valley. The Sara Lee TICKETS Fore CHARITY program has generated more than $3.7 million for Boise-area non-profit organizations since its inception.
Thanks to the Sara Lee TICKETS Fore CHARITY program, 100% of all ticket sales go directly to local charities. Sales are distributed monthly, so your purchase today will benefit your favorite charity during the holiday season.
A $300 value, but the cost of the ticket package is ONLY $150!
Place your order by December 15th and buy your 2012 ticket package in time to give a gift AND help your favorite charity this holiday season!
Idaho's Regional Early Childhood Committees seek parent participation: 20% of total membership will be parents of children with disabilities. Child with disabilities must be under age 13. RECC's advise and assist the implementation of the Infant Toddler Program (ITP) in the region. Infant Toddler Program operations are under the guidance and direction of the Regional Program Manager and Early Intervention Specialist. The RECC will facilitate the discussion of transition issues, eligibility issues and inter-agency issues in regard to early intervention services. A formal process exists for dispute resolution. REEC's disseminate public awareness materials for typical and atypical child development, infant toddler program information and education and evidenced-based practices for early childhood programs will take place annually.
The Early Childhood Coordinating Council also seeks parent participation. The EC3 is responsible for developing a sustainable and coordinated statewide-plan to achieve mutually defined goals for early care and learning with evidence-based outcomes and approval and support from stakeholders, as well as the Governor and will facilitate the activities of the Early Childhood Coordinating Council which will establish an ongoing communication network between state agencies, policymakers, families, stakeholders and communities for the purpose of planning and implementation of a coordinated system of early care and learning in Idaho. 20% of Council membership will be parents of young children with developmental delays or disabilities.
FREE Advocacy Workshops- Nov/Dec 2011:
TF Reformed Church:
You may attend mornings, afternoons or all day. Space is limited, to register visit http://www.medicaidmattersinidaho.com/DADMain.html
Legislative decisions that impact individuals with disabilities impact the lives of ALL members of our community. You are cordially invited to attend this year's Disability Advocacy Day Workshop created to empower and educate individuals to navigate and advocate through these challenging times of change. We will focus on this year's state level decisions, how the Medicaid system and the legislative process work, and how we can advocate as individuals on issues of concern to us all.
WHO SHOULD ATTEND? Everyone! Individuals with disabilities, parents, service providers and all community members. And, thanks to our sponsors, registration is free.
We offer these workshops in 4 locations throughout the state: Idaho Falls, Twin Falls, Boise and Coeur d'Alene.
We look forward to your joining us at the location nearest you! http://medicaidmattersinidaho.com/DADMain.html
Text4baby is an exciting new mobile information service, which sends three text messages each week to pregnant women and new moms to help them care for their health and give their babies the best possible start in life. Learn how to sigh up at http://www.text4baby.org
The goal of the Children's System Redesign is to implement a system of care that has an improved array of Medicaid benefits for children with developmental disabilities. Beginning July 1, 2011, children will be phased into the new system according to their birth dates. Be sure to visit the updated website for new information. www.redesignforchildren.medicaid.idaho.gov.
Sibshops is a program designed for brothers and sisters of kids with special needs. The Federation of Families will be hosting two separate dates on October 20th and November 19th. To register call 208.433.8845.