When a Doctor's Note Can Help: A Step-by-Step Guide to Obtaining a Useful Letter

When a Doctor's Note Can Help:

A Step-by-Step Guide to Obtaining a Useful Letter

Here's something that may help when you're having trouble getting schools to deal appropriately with your child's behavioral needs. It is essential that children with behavioral disabilities get training, not punishment, for their misunderstanding of the world and how it works. Schools are required by law to consider the professional recommendations of the doctors and therapists who treat our disabled children. When a doctor sends a letter of recommendations regarding educational interventions, behavioral, therapeutic, or medical interventions to be done at school, their expertise is supposed to be respected, considered, and implemented as much as possible so the child can derive the greatest benefit from his education.

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How to use this Checklist: (below)

1. Copy this checklist. This will be your master plan from year to year. Keeping this copy as your master will allow you to re-copy it for each IEP review and select only the items your child needs to use at the time.

2. Highlight the items your child needs for his behavior modification plan.

3. Take this list with you to your IEP review and ask the school secretary to make a list of it for each member of the team.

4. When behavior/discipline comes up, refer to the plan. Say something like, "I believe this plan will give us ways to handle his behaviors so that he learns from the discipline. We will see the unwanted behaviors disappearing while the desired behaviors will pop up more and more often. I understand this is the goal of discipline, is it not?"

5. If the team refuses this behavior plan, get a doctor's letter to state that your child requires it. Doctors and psychologists don't like seeing their patients repeatedly coming in with signs of emotional and mental abuse/battering by school personnel in
the guise of "discipline." Take your highlighted list to the doctor/ psychologist/mental health professional and ask for a letter of recommendation that states your child needs the specific points you have highlighted in a positive reinforcement behavior modification plan. The doctor's letter should conclude with something that includes the phrase, "this is my professional recommendation as the best practices that will allow (child's name) to have access to and benefit from his education."

6. Mail this letter of recommendation to everyone on the team, principal of the school, and the supervising authority, as well as to the members of the school board. Use it as the basis for a request for another IEP review. "Since a behavior plan was denied by the team at the last IEP review on (date), I have discussed (child's name)'s need for assistance with his doctor (neurologist, psychiatrist, etc.--name the specialty). Dr. (Name) maintains his professional opinion that (child's name) really does need a behavior plan and has given us the attached/enclosed letter of recommendation so that(child's name) can benefit from his education. Please let me know within 5 working days when the IEP review to add behavior modification to the IEP will be held. I will waive the right to 10 days prior notice if we can hold this meeting earlier."

7. Tape record this IEP review. Calmly ask for the exact reason why any one of these behavioral interventions cannot or
should not be used for your child. Upon denial of any item, request that the notice required by IDEA 97 stating exact reasons for the denial will be in your hands by 10 days after this meeting took place. And of course, whether the staff says yes or no, you will go home and write your own letter of understanding:

(Sample):

I understand that each teacher will receive a copy of (child's name)'s IEP and (child's name) will be placed in a weekly half-hour group session with other at-risk students; these are the only two of Dr. X's list of ten recommendations that have been added to the IEP to give (child's name) greater access to his education.

All the other recommendations by
Dr.X have been denied as listed below:

1. A complete behavior plan will not be used and no consideration will be given to what causes inappropriate behaviors.

Reason for denial:

not considered necessary by school staff.

2. No staff will be trained to deal appropriately with (child's name)'s
manifestations of his disability.

Reason for denial:

staff don't want to spend time in training

3. (Child's name)'s teachers will not have training for dealing with his disability in class.

Reason for denial:

teachers don't have time for training.

4. No checklist of highlights of training will be given teachers since
no training will be done.

Reason for denial:

No one needs highlights of no knowledge given.

6. No plan has been made for any individual who understands (child's
name)'s behavior to deal with inappropriate behaviors.

Reason for denial:

School staff feel that what is good enough for regular education students is fine for disabled students, regardless of its negative impact on disabled children.

7. No plan of action reached regarding exactly how outbursts will be handled. Parent has agreed that school must deal with these issues according to IDEA 97; school insists it can take me away from
work to deal with school discipline issues.

Reason for denial:

It's the way it's always been done.

8. No consulting psychiatrist or psychologist will be called for assistance or recommendations; (child's name)'s doctor/psychologist will not be called either.

Reason for denial:

School has a school psychologist who comes twice a week but who does not have
expertise in (child's name)'s disability.

10. No functional behavior analysis or more thorough evaluation will be done to determine if other factors, disabling conditions, or possible triggers to behavior have been overlooked.

Reason for denial:

Staff feels I need parenting lessons and should talk to (child's name) about
his behavior.

11. Mr. So-and-so who always seems to trigger the majority of inappropriate behaviors from my child will continue to have contact with him and may continue to provoke the incidents for which my son is always disciplined inappropriately.

Reason for denial of alternate person for my son's discipline:

"It's his job."

12. No progress notes will be used to notify parents of success/failure during school so that we might reinforce any training in these matters (yet we are supposed to "talk to him about his behavior"--based on what?).

Reason for denial:

It would take time.

"If I have misunderstood any part of this, please let me know in writing what is the correct understanding within 10 business days."

8. Then you will again enlist the doctor's kind assistance with another
letter to the principal which states,

(A)"...dismay that professional recommendations of best practices in this field of disability will not be followed, denying (child's name) optimum development of appropriate behaviors and coping skills, as well as appropriate access to his education" and

(B)"I will notify you in writing if punishment for symptoms of this child's disabilities continue to have a detrimental effect upon this child and his mental health. You are the administrator of the school and the lines of authority for disciplining this
child; since I have notified you of the proper management in view of his disability, I will consider you directly responsible for any continuation of punishment for this child's disability and will put it in writing should it cause this child harm."

Even if the school does not give you the required notice, even if they do not respond to your letter of understanding, you have now documented what has happened, which professional
recommendations are being ignored and why.

In schools where behavioral modification plans are not being used in
regular classrooms, teachers are often not trained in what behavioral modification plans are, how they work, how to adapt them, how easy they are to use, or even how successful they can be. There is a lot of fear that it is a LOT of extra work, that it takes a LOT of extra time, that it will take their time and attention from other students who need them. You can put things in perspective by offering to spend 30 minutes to train teachers in basic use of behavior modification for your child, and remind them that every single behavioral incident has taken more time than use of appropriate behavior modification would have
required.

Offer to remain as a "consulting partner for teachers." Do not cut
off communication. Remain as nice as you can be--get nicer if you can. No one can criticize Nice. Next to nasty, Nice shines all the brighter, with a good, healthy glow. Then keep doing what you have to do.

And P.S. Love your kid to pieces--he's got some good stuff in there!

CHECKLIST FOR MINIMUM BEHAVIOR

MODIFICATION PLAN:

1. Use a current and successful positive reinforcement behavior management plan. This plan should have a list of precipitators (causes) of (child's name)'s inappropriate behaviors/social responses. Add to this list anything that causes this child's behavior to become disorganized, disoriented.

2. Training for all administrative staff, security guards, cafeteria
staff, bus personnel, and any other staff who may need to know how to manage (child's name)'s behavior.

3. Training for all (child's name)'s teachers, with emphasis on his/her
triggers of inappropriate behaviors, responses, or outbursts (what to avoid) and emphasis on what to expect from (child's name) in certain situations and what to do for successful outcome.

4. Make a short summary checklist for teachers that highlights key points of training.

5. Make sure each of (child's name)'s teachers has a copy of the IEP.

6. Identify a single responsible individual with a counseling or clinical social work background to whom the student can always turn in case of problems which are beyond the student's own coping capacity. Identify one alternate in case (child) needs this
intervention in the absence of the primary helper.

7. Remove (name of administrator, teacher, any troublesome person who
represents constant conflict) from any association with (child's name) to minimize conflict and provocations.

8. Identify a single responsible individual with understanding of the
manifestations of (child's name)'s disability to manage disciplinary incidents. Identify an alternate for this as well.

9. Find a consulting (psychiatrist, psychologist, neurologist, etc.)
with expertise in (name of disability).

10. Assign (child's name) to a social skills training group which meets
regularly with a counselor or social worker (weekly or more often) for students with learning disabilities, behavioral disabilities, attention deficit disorders, or other at-risk conditions.

11. Give parents a weekly progress report or other regular method of
communication so they may reinforce and maintain continuity of discipline at home.

12. Give this plan a full trial of at least 6 weeks.

13. If this minimum behavioral modification plan is implemented
consistently in all classes and all settings does not work, a full,
functional behavioral analysis should be conducted in order to design a
behavior modification plan that does work.

copyright Michele Williams, 1998

(Michele Williams is Mom to two boys who have had a total of 10 diagnoses. In ten years of educational advocacy for her children and others, her BS in education has come in very handy for
identifying student needs and interventions. She is writing a book on attention deficit disorder. For permission to reprint or further information about this article, email Michele at:

gasamer@idt.net

Thank you for visiting my webpage.

blondie72@bellsouth.net

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