This article presents an overview of the history of service coordination for disabled and special education students in the public schools. Explanation of legislation and laws guiding social services is provided. It also discusses research and practice of service coordination and social work practice in the general community.
Keywords Case Management; Community-based Services; Early Intervention Programs; Individuals with Disabilities Education Act (IDEA); Service Coordination; Service Integration; Special Education
Service Coordination, or the coordination of services provided to families with children of special or complex needs, was mandated in the landmark special education legislation P.L. 94-142 in 1975 (now known as IDEA (2004), the Individuals with Disabilities Education Act). This mandate for the coordination of services was in response to widespread client feedback that referrals to service providers were not organized, sometimes inappropriate, and occasionally led to duplication or to gaps in services. Sometimes the specialized service providers, such as for mental health or financial assistance, did not have a holistic perspective on these families' lives, which again could lead to inappropriate referrals or gaps in service. In research considering the needs of children with complex medical needs coupled with developmental delays (Haflon & Klee, 1991), the studies found poorly coordinated services, providers who were spread over a large geographical area (or weren't available at all), poor reimbursement to providers, and cultural insensitivity.
In early social work the process of assessing all of a family's needs, problem solving and developing a plan for services, resources and treatment were considered best practices and competent, professional case management. This process of careful assessment was conceptualized and promoted by Mary Richmond in her classic social work text "Social Diagnosis" (1917) and again in her text "What is Social Case Work?" (1922). At that time, one worker would be responsible for assessing all of the family's needs and the same worker would either provide or broker resources for that client or family. As services possibilities and the number of agencies and providers of service increased, the need to coordinate these services became more important. Case management, which would include the coordination of services, assisting clients to access these services, and the development of new services, became one of the bedrock skills of the social work profession (Perlman, 1957; Compton, Galloway & Courmoyer, 2005).
The call for the coordination of services also came from insurance companies and federal and community funding sources, citing duplication of services and services being provided to individuals who may not be qualified for those services. The medical and health care systems were seeing more children with complex health needs, and were seeking a way to both expand their services to meet all of these critical needs, while cutting the costs involved in meeting those needs (Loomis, 1988). The increase in children with complex medical needs came with the increased awareness that treatment for these children may be hindered or supported by their familial, social, and economic environment (Haflon, Berkowitz, & Klee, 1993).
An additional issue that encouraged service coordination came from social work advocates of parents whose children had been removed for a variety of reasons by State Child Protection and Child Welfare services. These parents were required by the court to fulfill a wide number of requirements, many of which included connecting to treatment providers. Without coordination of these services or case management, these parents ran the risk of losing custody of their children because they could not fulfill all of the court's requirements in a timely way. The increase of drug-affected infants and children with elevated service requirements, in addition to families who needed treatment, for example, for alcoholism, domestic violence, and had their own complex medical needs underscored the need for coordination of services and careful case management between health, social work and child welfare services. These were not new problems, but there was a rising tendency for more critical problems to be concentrated in one family (Haflon, Berkowitz, & Klee, 1993). "Case management is a service delivery technique and organizing principle that can improve the coordination and integration of services and referrals, while decreasing obstacles to service access" (Haflon, Berkowitz, & Klee, 1993, p. 384).
The school systems echoed some of the same issues. When giving feedback about service delivery some of the difficulties included providers being spread over a wide geographic area, conflicting demands or directions from providers, lack of communication between providers, confusion about the availability of resources, and confusion about multiple funding sources. Adult clients and parents of children needing services wanted more say in the decision-making process, an increase in cultural relevancy in service provision and treatment goals, and a way to change the course of treatment in mid-stream, if the original plan was not working well.
The Law is Passed
Public Law 94-142, the Education for All Handicapped Children Act, was passed in 1975. It was amended in 1986 (P.L. 99-457), 1990 (P.L. 101-476), 1997 (P.L.105-17), and 2004 (P.L. 108-446) and is now know as the Individuals with Disabilities Education Act (IDEA). An additional law that affected special education was The Americans with Disabilities Act (ADA) (P.L. 101-336) passed in 1990, which guaranteed equal access and protected civil rights in the areas of private-sector employment, public services, public accommodations, and telecommunications.
IDEA, with all of its amendments, requires that children 3-21 years old with a disability be provided with a "free, appropriate, public education in the least restrictive environment." The 1986 IDEA amendment extended the provisions of the 1975 version to include children from 3-5 years, and incentives for States to develop Early Intervention Programs for children with disabilities ages birth to 3 years (Part C of IDEA). Part C also mandated Service Coordination in the 1997 amendment of IDEA. The benefits of service coordination were partially documented by Dinnebeil, Hale, and Rule (1999), Roberts, Innocenti, and Goetz (1999), and Summers, et al, (2001). Service coordination reflected best practices and in response to consumer demands, addressed many of the above-mentioned issues.
There were three specific directives in the IDEA which are necessary in the provision of service coordination. The first was a central person that was to be responsible for coordination all of the services for a specific client. The second was a document that guided the coordination and the third mandated policies for interagency coordination and cooperation (Bruder, Harbin, et al., 2004).
A service coordination team would ideally consist of a service coordinator, the client, parents of minor clients, involved family members (such as caretaking grandparents), and all of the service providers. The service provider representatives would ideally reflect all those who would meet all of the child's developmental, educational, and medical treatment needs. The team was intended to be participatory (where all stake holders have input), family-centered, and based in the community where the families reside. This also reflected the report of the US Surgeon General C. Everett Koop (1987) which called for a national system to coordinate the services for families with children with special health care needs which was family-centered and community- based. Family-centered care is defined as care in which the family is seen in the pivotal role, and their input, wishes, cultural norms, and strengths are respected and supported (Brewer, McPherson, Magrab, & Hutchinson, 1989). Community-based care supports the philosophy that children with special needs should live at home with their families and receive education and services in their local communities, as much as possible. Ideally, the service coordination team members would be living in this child's home community
Point of Entry
The point of entry for a client includes assessment of their developmental level and diagnosis of any disabilities and medical conditions. If they meet the criteria of the IDEA, they are enrolled in the available programs, where they are referred to service providers. Point of entry for children with complex health needs is usually through medical services and tends to be early in their lives, as infants and toddlers (Nolan, Young, Hebert & Wilding, 2005). Point of entry for those with uncomplicated developmental delays tends to be dependent on the nature of their delays, but tends to be through medical or educational channels. Point of entry for children and youth with serious emotional disturbance tends to come through educational channels, juvenile justice, or child welfare systems (Unger, 2005; Wright, et al., 2006).
Service Coordination in Special Education
Once a child has entered the system and found to qualify for services (therefore under the purview of IDEA) the local education agency (LEA) becomes responsible for the coordination of their services (McAffee & Grumwalt, 2001). The LEA will retain responsibility for this child's service coordination from birth (Early Intervention programs), through their pre-school, elementary school, their Individual Education Plans (IEPs), their Family Service Plan (FSP), and the writing and implementing of their transition plan (ITEP) in their early adolescence (no later than 14 years of age). The LEAs responsibility usually ends when the child graduates from high school or ages out of the system (reaches 18-21 years of age). The exception to this is if the LEA is found (usually through a legal challenge brought by the parents or guardians) to not have written an appropriate plan or adequately implemented an existing ITEP. Post-secondary education is then seen as compensatory to the free public education as required by the IDEA (McAffee & Grunwald, 2001).
The earliest coordination of services happens as part of the Early Intervention programs (EIP), for infants and toddlers 0-3 years of age. Nolan, Young, Herbert & Wilding, (2005) documented the increasing number of children who, through improved medical technology, are surviving premature birth and birth from drug-affected mothers. These infants are found to be at high risk for physical and...
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