How does your school make the distinction between the two?

Discuss the differences between health services and medical services as stipulated by the courts. Discuss a typical student needing health services and a typical student needing medical services. How does your school make the distinction between the two?


Supplemental Service


Supplemental and related services for children with disabilities have greatly evolved with the reauthorizations of the Individuals with Disabilities Education Act (IDEA 1990); first in 1997 (IDEA 1997), and again when it was renamed the Individuals with Disabilities Education Improvement Act (IDEIA), referred to as IDEA 2004. Each reauthorization brings more services and greater specificity, and further definitions of terms.

The most current version, IDEA 2004, mandates that related services must be made available when they are needed to assist special-education children in benefiting from their programs. Included in these related services are transportation, speech pathology, auditory services, psychological treatment, social work, counseling services, mobility services, and occupational, physical, and recreational therapy. IDEA 2004 also includes diagnostic medical services and assistive technology. Furthermore, other, supplemental services can be added when the Individualized Education Program (IEP) team agrees they are necessary.

Related Service Cases

Educators can write as many IEPs as possible, but if a child does not have transportation to school, the effort is useless. The courts have handed down various rulings addressing transportation issues as they apply to disabled students; however, a child with a physical disability may need more assistance than a typical school bus can provide. Therefore, the courts have ordered districts to provide special forms of transportation. For example, although a school bus is provided, the child may still need assistance to get from his house to the bus. For that reason, the court ruled that the district must provide an assistant or compensate the parents for transporting the child themselves (Hurry v. Jones, 1984).

There has been some controversy over IDEA’s related-service provision for counseling services. The debate centers on the medical exclusion clause in IDEA: Services are guaranteed in the new regulations if they are necessary for children to benefit from their special education programs; however, schools are not required to provide medical services except for diagnostic purposes. Some parents have sought to have districts pay for psychotherapy for their children. The problem occurs because sometimes counseling can be considered a psychological service as defined by IDEA 2004, but at other times, it is a medical therapy.

The decision as to whether counseling is an allowed related service is often contingent on state laws, which govern who can provide psychotherapy. In some states, only a psychiatrist, a licensed physician, is allowed to perform psychotherapy. Other states allow psychologists to administer psychological therapy. Many courts have looked to the dictionary for their definition of psychotherapy, where the term is described as a psychological service. Using this definition, the courts believe psychotherapy is a related service as described by IDEA 1997. Cases that have come before the court regarding medical exclusion have often been decided in the favor of the parents. In one such case, a federal court ruled that the child clearly required the service in order to benefit from his special education program (In reThe A Family, 1979).

In another medical-related issue, some parents have sued school districts over payment for substance-abuse treatment. School authorities often caught children diagnosed with disabilities with some illegal substance. Generally, the courts have ruled that substance-abuse programs are medical services and therefore not the responsibility of the school district (Armstrong by Steffensen v. Alicante School, 1999).

Can school districts be forced to alter the physical structure of a building to meet the related-service demand of IDEA 2004? The answer, in some cases, has been yes. A federal court in Texas ruled that a school district had to provide an air-conditioned classroom for a brain-injured child who could not control his own body temperature (Espino v. Besteiro, 1981). The idea of providing an air-conditioned classroom would seem normal to most people, but the district had placed the child in a special temperature-controlled cubical away from the other children. This meant that he had minimal social contact and his educational environment was highly restricted. The parents felt their child was not receiving an appropriate education in the least-restrictive environment. The court agreed.

Transition from high school to the real world has often proven difficult for students with disabilities. For many years, there were no available services to help make this event successful. Very few districts had a tracking system to evaluate what special education students did after graduation. Studies were conducted which found that the disabled had a much higher rate of unemployment than their nondisabled peers. IDEA 1997 addressed this issue when it incorporated transition as a related service. The courts have described transition services as those that provide instruction to prepare students for life outside the school system (East Penn School District v. Scott B., 1999). If the IEP team decides it is necessary, services such as vocational training, life skills, and employment mentoring must be provided prior to graduation.


Supplemental and related services encompass a large variety of accommodations made on behalf of disabled children. Many of these services are costly to local school districts; however, IDEA and the courts demand that schools meet those demands, regardless of cost.


Armstrong by Steffensen v. Alicante School, 44 F. Supp. 2d. 1087 (E.D. Cal. 1999).

East Penn School District v. Scott B., 1999 WL 178363 (E.D. Pa. 1999).

Espino v. Besteiro, 520 F. Supp. 905 (S.D. Tex. 1981).

Individuals with Disabilities Education Act, Pub. L. No. 101-476, 104 (1990).

Individuals with Disabilities Education Act, Pub. L. No. 105-17, (1997).

Individuals with Disabilities Education Act, Pub. L. No. 94-142, § 20 U.S.C. 1400 (2004).

In re the A family, 602 P. 2d 157 (Mont. 1979).

Hurry v. Jones, 560 F. Supp. 500 (D.R.I. 1983), affirmed in part, reversed in part, 734 F.2d 879 (1st Cir. 1984).

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