The Patient Population Factor
IDEA and Section 504 are federal laws that ensure special education services for all children in the United States who need them. Despite some regional specifications, this legislation theoretically applies equally to every school district, in every classroom, and at every desk. In Dr. Classen’s experience, this isn’t the case.
Once, she recalls, she was talking with a lawyer from the Office of Civil Rights, a legal aid agency within the U.S. Department of Education to which she often refers families. The lawyer told her that she’d been sending them a lot of cases since she’d started practicing in North Carolina, and that they often see this kind of activity when a physician moves from a hub like New York or California to a more rural area. “We start getting all these cases from them,” Dr. Classen paraphrases the lawyer, “but you can’t expect kids to get the same kind of school there that they would in California.” She remembers responding, somewhat sarcastically: “I’m pretty sure it’s every child guaranteed an equal education, not children in California guaranteed a better education than the children in North Carolina.”
So, why do these two communities handle special education so differently? Dr. Classen doesn’t need much prompting to come to an answer. “They don’t take care of poor children in the United States.”
It is no secret that public education is underfunded across the United States, and in impoverished communities, like those Dr. Classen serves, the lack of resources is even more severe. A very small portion of an already small budget is allocated to special education services. In order to meet these stringent financial requirements, school administrations overlook students’ needs for special accommodations, and sometimes actively deter parents from requesting IEP evaluations for their children.
Dr. Classen stresses that it isn’t the children’s teachers who try to withhold special education from children who need it. More than once she’s had a teacher come up to her after an IEP meeting to thank her for advocating for a child. “They say to me, ‘I just want to let you know, I agree with everything you said, I just can’t say it.’ Their hands are tied.”
A key facet of the IDEA legislation is the Child Find mandate, which dictates that states and school districts must locate, identify and evaluate all children with disabilities who require educational assistance. In theory, the school would look for students showing signs of a disability, watching for indicators like low End-of-Grade (EOG) test scores, and take the initiative to enroll these students in special education. In reality, Dr. Classen recalls seeing patients who were nearly failing out of their classes and receiving no special assistance at all. She wonders: “What is the point of doing the testing?!”
If the schools overlook these warning signs, a child’s parents are left on their own to seek out special education services. In rural North Carolina, Dr. Classen observes that many of her parents, who may be undereducated themselves, don’t know what red flags to look for. At appointments, she makes it a point to bring up the children’s academic performance and ask specific questions about their grades and EOG scores. If she finds a cause for concern, she encourages the parents to file a formal request with school administration for a disability evaluation.
Dr. Classen believes that the schools she works with will sometimes try to deter the parents from pursuing these requests. They use tactics which prey on the parents’ natural fears about their child and their own ability as a caretaker, or exploit the parent’s lack of education and financial resources. Dr. Classen finds that parents in low-income communities are especially susceptible to these tactics, and are less likely to advocate for themselves and their child in the face of pressure from a strong institution like a school administration. “They get kicked around everywhere,” she says, and they lose the motivation to fight back. Dr. Classen doesn’t let them stay down for long. She works hard to encourage their efforts and give them the confidence to stand up to school administrators. She says: “I think of what I do as being a cheerleader.”
“What we say as doctors to parents has a lot of power,” she notes. “It can be so significant to just tell them: You are right, and you are being a great advocate for your kid, and don’t you dare let them make you feel like you’re a bad parent! I think a lot of times just telling people that they’re doing a good job and supporting them is so important.”
In communities like Dr. Classen’s, where these parents so rarely hear positive feedback, her encouragement makes a huge difference. Parents praise her personal touch in online reviews. “Thank you for always treating us like we were people,” one parent writes, “and not just another case.”