Federal Government Urges Schools To Tackle the Bullying Of Kids With Disabilities

In new guidance sent to educators across the country, federal education officials say that schools may be liable if they don’t properly address bullying of students with disabilities.

The guidance issued Tuesday in a four-page “Dear Colleague” letter details the unique obligations that schools have under the Individuals with Disabilities Education Act to ensure that children with disabilities are not victimized.

Specifically, officials from the U.S. Department of Education’s Office of Special Education and Rehabilitative Services said that bullying can lead to a denial of a student’s right to a free and appropriate public education, or FAPE, if it “results in the student not receiving meaningful educational benefit.”

What’s more, they warned schools not to automatically move a student with a disability who is being bullied to a more segregated environment. Such a change could be considered a denial of a student’s right to be educated in the least restrictive environment, the guidance said.

“We know that students with disabilities are disproportionately affected by bullying,” said Melody Musgrove, director of the Education Department’s Office of Special Education Programs. “Schools have a responsibility to ensure that FAPE and the least restrictive environment is available to students with disabilities.”

In cases where bullying occurs, educators should intervene immediately and respond “quickly and consistently,” according to the letter signed by Musgrove and Michael Yudin, acting assistant secretary for the Office of Special Education and Rehabilitative Services.

Additionally, a meeting of the student’s individualized education program team should be called to address any changes in a student’s services or program that might be needed as a result of bullying, officials said. However, the letter indicates that any student who experiences bullying should remain in his or her original placement unless they are no longer able to receive FAPE in that environment.

Musgrove said that the move to issue guidance is part of the Department of Education’s ongoing effort to address bullying within the nation’s schools. While the letter does not detail any new legal obligations, federal officials are encouraging schools to re-evaluate their policies and practices.

Several studies in recent years have suggested that children with disabilities more frequently encounter bullying. Findings released in 2012 from a nationwide poll indicated that 63 percent of kids with autism have been bullied. Another study published the same year found that about half of adolescents with autism, intellectual disability, speech impairments and learning disabilities were bullied at school.

Ari Ne’eman, president of the Autistic Self Advocacy Network, called the Education Department’s move a “significant step forward.”

“Right now, many autistic students experiencing bullying are sent to segregated settings,” Ne’eman said. “We believe this clarification of obligations emerging under IDEA’s (least restrictive environment) provision may have a significant impact on the inclusion of autistic students as well as those with other disabilities.”

Written by: Michelle Diament (disabilityscoop.com)

Innovations in Advance Care Planning

As an Elder Law attorney, I strive to ensure that all individuals know the importance of documenting their end of life wishes. Here is an interesting article about a new way in which those in the medical profession are working to document the wishes of their patients.

A Novel Way to Document End-of-Life Preferences

By Paula Span

Maybe we’ve been going about this all wrong.

In the continuing campaign to get people, particularly the old and sick, to discuss their preferences for end-of-life care, we’ve been pushing for them to have intimate conversations with family members.

Web sites like The Conversation Project and PREPARE, campaigns like National Healthcare Decisions Day in April, my own posts here — all reflect the idea that Americans can overcome their apparent aversion to acknowledging mortality if their children will just talk to them.

Progress on this front has been slow, however. Pew Research surveys found in 1990 that 12 percent of Americans had a “living will,” a figure that rose to just 29 percent by 2005. So on a nearly daily basis, the palliative care specialist Dr. Joshua Lakin told me in an interview, “I’d see someone who’d had lung cancer for several years, who’d been in and out of the hospital, had seen 20 doctors, and still hadn’t thought about the future and his priorities. It kind of blindsided me.”

So Dr. Lakin, who just completed a fellowship at the University of California, San Francisco, and some colleagues took an entirely different approach to what is called advance care planning. They experimented with brib . . . er, incentivizing doctors. And whaddya know, it worked.

As the team reported in JAMA Internal Medicine last week, the UCSF Medical Center has an incentive program to improve quality; each year its doctors-in-training pick one area to focus on. For the 2011-2012 academic year, the internal medicine department decided to concentrate on documenting patients’ advance care decisions.

The researchers came up with a standard form, which was inserted in patients’ electronic health records. It asked just a few questions: Does the patient have any “expressed wishes” about how much care he wants or doesn’t? Where are those preferences recorded — in a living will, a durable power of attorney, a P.O.L.S.T. form (which would be scanned into the record). Or are they expressed orally?

The researchers’ form requests a brief summary: He doesn’t want to be resuscitated or intubated? She wants a feeding tube but not a ventilator? Or she wants “all available care?” Does he have a designated decision maker? What is that person’s name and phone number, and what language does he or she speak?

If residents recorded this information for at least 75 percent of discharged patients, for three of the four quarters in the academic year, they each got a $400 bonus. If not, they didn’t.

The hospital, not the researchers, established that sum, but “it was enough to get people motivated,” Dr. Lakin noted. Residents around the country earn between $40,000 and $50,000 a year, plus housing stipends. An additional 400 dollars isn’t life-changing, but it’s not pin money, either. And the researchers sent out bar graphs via e-mail to point out if teams were hitting the goal or endangering everyone’s bonus. (“Marketing 101,” Dr. Lakin called it.)

The experiment followed nearly 1,500 patients, more than half the adults (of all ages) seen by the hospital’s medical department that year.

In July, the first month, only about 22 percent had their preferences documented, roughly the same proportion as before the incentives began. So “the template itself wasn’t enough,” Dr. Lakin said.

But by October, following Marketing 101, the proportion of patients with documented preferences hit 90 percent and stayed there. By contrast, a separate team of attending physicians who didn’t participate in the incentive program averaged less than 12 percent for the year.

So maybe we don’t have to keep nudzhing our parents, bracing for uncomfortable discussions. Maybe a doctor, at a hospital or not, can do this in 10 minutes without angst.

Of course, the study doesn’t answer some major questions. We don’t know how much of an incentive, if any, would motivate practicing physicians, who are paid more than residents. We also don’t know whether simply having a standard form in your medical records means that you will actually have your wishes respected — that you’ll be put on a ventilator if you said you’d want that, but not if you said you didn’t.

But we do have some idea of the scenario that ensues when people have never discussed their wishes. The medical conveyor belt cranks up. “There’s a set of default choices in the hospital system, which does things unless told not to,” Dr. Lakin said.

I’d still rather have the family conversation. But so often, it never takes place. Stricken families, sometimes bitterly at odds, wonder what Mom would want if she could speak. Maybe nobody really knows. Maybe, for a paltry sum compared with the cost of a single day in intensive care, her doctor could have found out.

Forty Percent of Adults Care For Sick, Elderly Relatives

Four in 10 U.S. adults are now caring for a sick or elderly family member as more people develop chronic illnesses and the population ages, a new study has found. "More health care is happening at home," said Susannah Fox, Associate Director of the Pew Research Center's Internet and American Life project and the study's lead author. "As more people are able to be saved by medical advances, their lives are being extended, but they're also being sent home medically fragile. It's caregivers who are the first line of defense." Researchers surveyed 3,014 adults nationwide and found that most caregivers were between 30 and 64 years old. They found that the number of caregivers increased 10 percent between 2010 and 2013. Fox also said the slow U.S. economy could explain why family members are becoming more responsible for care. With fewer or depleted savings, many people are less able to hire professional help, she said. About half of the United States population has at least one chronic condition, according to the Centers for Disease Control and Prevention. Adults ages 65 and older, 75 percent of whom have chronic conditions, are expected to make up 19 percent of the population by 2030, compared with 12 percent in 2000.

Source: Reuters

Updates to State Medicaid Eligibility and Enrollment Systems - CIOs Survey

This weekend, the final 100-day countdown to open enrollment begins. Will state Medicaid eligibility and enrollment systems be ready? Results from a recent survey published by the National Association of State Chief Information Officers (NASCIO) and the Healthcare Information and Management Systems Society (HIMSS) indicate that 72% of the 26 states and/or territories that responded report that their state or territory will be implementing a new system before 2014, when new eligibility and enrollment processes kick in.

States that participated in the survey overwhelmingly responded that most of the funding comes from the 90 percent federal match that is available for eligibility and enrollment systems development and implementation through 2015. Two-thirds (68%) of the state chief information officers (CIO) indicate they currently leverage the Medicaid eligibility system to benefit other social service programs. (Other programs can benefit from the Medicaid upgrade.

If the Medicaid system needs a feature, other programs can benefit and pay any additional cost for integrating the other program. Disappointingly, only 22 percent of states with state-based marketplaces (SBM) were definite about integrating Medicaid and the SBM systems. Over half (56%) were still undecided.

But let’s get back to the system readiness question. CMS is busily working with state Medicaid and CHIP agencies on contingency planning. To the extent that, even temporarily, states will be implementing “work-arounds,” it is important for navigators, assisters and other stakeholders to understand how any interim eligibility and enrollment processes will work. Some states are discussing their contingency plans in open door meetings, but others may be planning behind the scenes. As we get closer to open enrollment, it’s important for states to be transparent about how things will work on day one, and beyond as changes are introduced. By setting expectations openly, states may save themselves a lot of headaches even when things are working according to the contingency plan because stakeholders didn’t know what to expect.

Don’t know what your state is up to? Ask for a copy of the contingency plan, or better still, ask to participate in the contingency planning process so that the needs of consumers are well represented as key decisions are being made.

Source: Tricia Brooks

             ccf.georgetown.edu

New Online Guide for Seniors: Combatting Financial Fraud

WASHINGTON — U.S. regulators have a new guide for teaching older adults how to detect financial scams and avoid being exploited.

The curriculum was developed by the Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau. It has been designed to instruct seniors and their caregivers and is targeted for use by employees of financial firms, adult protective service agencies, senior advocate groups, as well as law enforcement personnel.

The free curriculum, titled “Money Smart for Older Adults,” includes an instructor guide, a participant guide, and Power Point slides. It can be accessed online at:

http://www.fdic.gov/consumers/consumer/moneysmart/OlderAdult.html.

The guide notes warning signs that seniors should look out for, such as people asking for personal information over the phone.

Source: The Associated Press

Governmental Plans to Enhance Transition Services Nationwide

A key U.S. senator is pushing for expanded on-the-job opportunities for youth with disabilities while they are still in school, and he’s making the issue a top priority as Congress looks to tackle a major employment bill.

Sen. Tom Harkin, D-Iowa, said he is currently working to bring a reauthorization of the Workforce Investment Act up for consideration. As part of that process, Harkin said this week that he would like to see vocational rehabilitation agencies take a bigger role in facilitating internships and other real-world experiences for students with disabilities who are in transition.

Currently, access to vocational rehabilitation varies widely from state to state, with employment services available to young people with special needs in some locations, but not others. Harkin is looking to change that.

An aide for the senator told Disability Scoop that Harkin wants to require vocational rehabilitation agencies in each state to set aside at least 10 percent of their funding to provide “pre-employment transition services” for students with disabilities. This could mean offering everything from skills training to internships, summer jobs and apprenticeships as a complement to the transition services provided by schools under the Individuals with Disabilities Education Act.

“I am committed to raising employment rates for Americans with disabilities, and one of the most effective and lasting ways we can achieve that is to ensure that young people with disabilities have access to the summer jobs, internships and experiences in competitive employment that can be a springboard to a career,” Harkin said in a statement to Disability Scoop. “Improving services to young people with disabilities will be a central focus for me in the reauthorization of the Workforce Investment Act.”

Staffers for Harkin, who chairs the Senate’s Health, Education, Labor and Pensions Committee, said early conversations with the panel’s top Republican, Sen. Lamar Alexander, R-Tenn., suggest that there’s bipartisan support for the plan.

Harkin said he expects to have a bill ready for consideration by late summer or early fall.

Source: Michelle Diament

             disabilityscoop.com