John A. Butler

Health care access and use among handicapped students in five public school systems.

The authors studied the health care access and utilization patterns for a stratified random sample of 1,726 special education students in five large metropolitan school systems. Overall, 7% of the special education students had no regular source of care, 26% had no regular physician, and 38% had not visited a physician in the previous year; 13% had no health insurance. Each of these measures was worse for nonwhite and poorer children as well as for those whose mothers who had less formal education. Insurance coverage was associated with physician visits, with 45% of the uninsured children visiting a physician compared with 63% of those with public insurance and 66% of those with private insurance. Odds ratios for all health care access and use measures showed striking geographic variations. Thus, even for children identified as handicapped by their communities, barriers to health care are evident and are significantly greater for groups traditionally at risk.

Variation in Special Education Classification Across School Districts: How Does Where You Live Affect What You Are Labeled?

Using independent information collected from the parents and teachers of a stratified random sample of 829 special education students, we compared the classification practices of five major metropolitan school districts. We examined the functional levels of students with the same labels living in different districts and tested whether differences in functional status were associated with the prevalence of the classification. To determine whether special education designations might change if the students lived elsewhere, we reclassified the students in each district’s sample using discriminant functions estimated within each of the other districts (which empirically replicated that district’s classification scheme). We found that (a) functional levels of students classified as mentally retarded, physically/multiply handicapped and hearing impaired differed across districts; (b) districts that classified more students as mentally retarded were serving less severely impaired students under this label; and (c) districts were least consistent in their use of the mentally retarded and emotionally disturbed designations and most consistent in their use of the hearing impaired and, to a lesser extent, physically/multiply handicapped designations; districts’ use of the speech impaired and learning disabled designations fell between these two extremes.

New directions in the evaluation and education of handicapped children.

The Education for All Handicapped Children Act of 1975, which went into effect last October, ensures the right of handicapped children to free appropriate public education. State and local education agencies are required to identify, evaluate and provide services for all disabled children. This multibilliondollar program will guarantee special education resources for up to 12 per cent of American children. A role for physicians in the program is implied rather than defined in the law. Their involvement will vary somewhat from state to state, but will at a minimum involve counseling parents whose children are under evaluation. The law assumes a sophistication of diagnostic ability and curriculum design that does not yet exist, and therefore places a special burden upon physicians to deal effectively with patients now, while developing better training programs and assessment tools, and makes essential the enhancement of the communication between doctors and educators.

Characteristics of Special Education Placements: Findings From Probability Samples in Five Metropolitan School Districts:

Characteristics of classroom placements were studied for a probability sample of approximately 950 special needs children enrolled in kindergarten through sixth grade in five major metropolitan school districts. Across all special education students, 58% spent the majority of their school day in a regular class, 38% spent the majority of their school day in a special class, and 4% attended special schools. The regular classes in which special education children were enrolled resembled other regular classes in overall size and student composition. By contrast, special classes were smaller and more heterogeneous, and classes in special schools were especially small and heterogeneous. The proportion of time spent in regular education varied significantly both by the childs primary handicap and the school district in which the child lived, but sizable variations also were found within disability groups and within districts. For learning-disabled, mentally retarded, and physically/multiply handicapped children, variations in placement were found to be associated with student socioeconomic status and race or ethnicity.

Issues in the Financing of Care for Chronically III Children and Their Families

Existing data do not yet permit a comprehensive understanding of expenditures for the care of chronically ill children. But it is known that the care required by these children is often far more expensive and takes place recurrently over a far longer interval than for other children. It also is known that many families experience significant out-of-pocket expenditures because of serious limitations in private insurance policies and serious inequities from state to state in eligibility criteria for Medicaid and other public programs. These and related issues must be addressed if we as a nation hope to target resources more fairly to this particularly needy group of children and their families.