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Posted March 18, 2005

Request: How should/can special education departments share the IEP with the medical home? Specifically, has anyone developed a form used by schools to communicate the IEP services that the child has as part of their special education program--"The pediatricians say they would like to know what services the child is having in school however all parties agree that sending a copy of the entire IEP is to cumbersome and the physician does not have time to sort through the IEP". Please submit any forms, communication tools or suggestions.

Responses:

IEP Communication Tools/Resources:

• A practice in Utah, has developed two forms to communicate needs of CSHCN with their school.
  • .Medical Home - School Information Release form authorizes the exchange of information between the student's health care provider and school professionals as it relates to the diagnosis/condition listed. The form is a basic release of information that allows the medical home to communicate with the school and vice versa.
  • The Medical Home´School - Evaluation/Services Form serves as a communication tool between the student’s health care provider and school professionals as it relates to health concerns that may impact the student’s education. This form allows the medical home to request evaluations of the school and to also communicate with the school areas of concern.

  Both forms were developed with the State Office of Education, so the terminology is acceptable to both the school districts and medical doctors providing services to CSHCN.

• A practice in Massachusetts is using a letter to request a full assessment to see what school services the child is eligible for or services being provided. The letter is given to parents/caregivers of CSHCN to forward on to their child's principal.

• This letter originally written by Martin Stein, MD and Barbara Lounsbury MD has been abstracted from an article in the Journal of Developmental Behavioral Pediatrics. A Child with a Learning Difficulty: Navigating School Based Services. 2004;Supplement:S33-S37

With the permission of Dr. Stein, this practice includes the letter as a template in their electronic medical record system and is given to parents to deliver to the school when problems arise. A sample of the letter modified for this MA office can be found by clicking here.

• Alabama's Early Intervention Program has developed a form to help communicate information to the physician. The form is available to service coordinators by order request as a 3 copy NCR form or 1 page letter format. The form can also be downloaded from their web site, www.rehab.state.al.us/ei With the family's/caregiver's approval, service coordinators are responsible for completing the form and providing copies to the family and primary physician. State monitoring staff review records to ensure use of the form.
  
  
• In New Jersey, many school districts use an IEP summary form that they share with general educators so that those teachers have a snapshot view of the services the child is receiving and the kinds of accommodations that they are responsible for. It seems that this sort of form would be useful for the medical home as well.
  
• A state of Washington Advisory Team for a special education department developed an IEP summary form that they share with any professional who is working with the child. It is a snapshot view of the services the child is receiving and the kinds of accommodations that are needed.

IEP Communication Ideas/Opinions:

Family Centered

• The Arizona Early Intervention Program thinks meaningful sharing of the IEP/IFSP information should come through the family. When families learn through parent/family involvement that they can share this information, it provides an opportunity to learn the many different ways we advocate for our families.
  
  In the early intervention program at our center, pediatricians want to know what happened after they made the referral, what services are being provided or what evaluations/assessments are scheduled. They request certain pages of the IFSP to gain a better understanding of where the child and family are in services that are being received.

Doctor's usually do not get involved through any other avenues unless they serve a large population of children with special needs. The relationships developed by families with physicians can go so much further in educating them on how beneficial their support is in children's lives.

• A physician in New Jersey believes that it is the family's responsibility to receive or request a copy of the child's IEP and identify the appropriate section(s) to give to the physician.

School Centered

• A school health program in Georgia believes that school nurses provide the best link to the medical home. It is common to have school nurses participate in the IEP process, especially when a medical condition is present. School nurses can be the "linch pen" that provides an important link between, the family, student, physician and school. School nurses are also able to identify issues relevant to HIPPA compliance.
  
  Some school systems have forms that parents sign (if the child has a chronic disease) giving the school nurse permission to contact the physician regarding certain conditions and associated medications. We do not have copies of such forms.
  
  
• In North Dakota, a monthly meeting is conducted with professionals to review client information - all the professionals currently working with the child and family were invited to attend these meetings. The sessions lasted approximately 1 hour and were progressive meetings. Information pertaining to a child was discussed and other services were identified as needed/recommended from this team meeting. The establishment of a tracking system was in place during that time.
  
  
• A physician in Rhode Island, states that his practice does not have a specific release form for IEPs, but the general release of information form signed by a parent includes all educational testing results and a copy of the IEP. The release form also indicates a two way communication between staff and the school. This has been almost universally successful. Not only are the school special education offices willing to communicate but often are eager. There are often medical and health care concerns about children in special education programs and the schools seem to appreciate being able to discuss these issues with the child's primary care pediatrician. This also opens the door for communication about behavioral and health issues that might arise during the school year.
  
  
• A special educator in Wisconsin suggests that on the initial paper work required for IEP's, a line be added or checked requesting a copy of the summary to be sent to a child's physician. This special educator is on the State Superintendent's Special Education Advisory Board and is looking into how difficult it would be to add the box on to their forms. The actual summary is usually only one page, that also may include a listing of the child's goals, with when and where those goals are to be addressed.
  
  
  Practice Management
• A physician in San Diego, states that this is a problem they have been grappling with at city schools. Most doctors would at the very least like to know that their patient is receiving OT and PT and speech at school, let alone more traditional educational interventions.
  
  Schools have a problem, too. Unless the parent makes a specific request at the IEP to have a copy of the IEP sent to their doctor, it doesn't happen. Personally, in my practice I have parents bring in their copy of the IEP and then I copy the portions that interest me.
  
  No good solutions for systemic change that I can think of --- but I am glad there are more "minds" working on this, than just mine.
  
  
• A physician in NYC, states that in clinics and public schools, records are still hand-written, no one has secretarial help, and no one wants to fill out one more form. The IEP has the most relevant information on the summary on the first two pages, but it is hard to interpret because the terminology is vague. More helpful than the IEP would be the evaluation itself, which parents can obtain at their informing meeting when the IEP is given to them, but only if they ask. We can advocate much better for the kids if we know what the findings were, so I'd rather see an effort to obtain the full evaluation than the IEP.
  
  
  General
• A member of a Quality Improvement Team for Pediatric Health Associates in Naperville, Illinois believes there is no short and sweet IEP summary. There are usually 3-4 pages that are key that would probably give an overview of the services. These would include pages that address the minutes of each service (Educational Services and Placement), any Behavioral Intervention Plan, the sheet marked Educational Accommodations, and the page where transition, transfer of rights, transportation, school supports, and extended school year are addressed with the funding tracking system on the bottom. Basically that would be the IEP without the Goals and Objectives/Benchmarks sheets. I think you'd be hard pressed to get a district to fill out any form you come up with since the information is already in the IEP.
  
  Issues to Consider with IEP Communication:
  
  HIPPA/FERPA Related
• A physician in Georgia states, "I get the entire report from Early Intervention" and also get whatever the parent brings to clinic from the IEP. The problem with both is that it is not a covered entity for HIPPA, so HIPPA forms must be completed to communicate. It gets a little tricky. It shouldn't. We need to communicate!
  
  
• A Senior Public Health Analyst from the Maternal and Child Health Bureau is interested to know if anyone has dealt with any issues around privacy/confidentiality? Issues regarding FERPA and the sharing of information in a child's education file, (i.e. IEP with public health or the child's health care provider)?
  
  The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.
  FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students."
  
  If you have addressed FERPA, it would be helpful to learn any lessons that you can provide.
  Please send any lessons learned to: medical_home@aap.org so that they can be posted to this bulletin board for anyone who also may be interested in the information.
  
  Insurance/Managed Care
• A family support specialist in Missouri would like to bring up the issue that some insurance companies are requesting copies of the child's IEP to determine what therapy services they will pay for, stating that they can't pay for services the child is already receiving (duplication of services). Although she doesn't agree with this logic, she thought the issue needs to be considered when looking at how information about the IEP may be used in relation to medical home (and funding for services).