Homebound hospital program outcomes and implementation

Homebound Instruction

Federal Regulations

In Title 34 of federal codes, part 300, titled Assistance to States for the Education of Children with Disabilities, federal guidelines specify that state educational institutions are responsible for providing specially designed instruction for students with disabilities. Specifically, section 300.26 lays guidelines for the provision of such services, the settings in which such services are to be provided, and the specifications for such provisions (34CFR300.26). In response, all fifty states now offer programs, including homebound and hospitalized services for students unable to attend regular classes due to medical conditions. This paper will discuss such programs, including the federal guidelines, specific state programs, an overview of services, and a discussion of each state's particular requirements for the homebound or hospital programs.

To understand the role of federal guidelines in establishing precedent for homebound and hospital educational services, it is necessary to understand guidelines regarding special education. As mentioned, Title 34 of federal code specifically details the requirements for the provision of special education classes for students with disabilities. According to section 300.26 of Title 34, special education refers to "specifically designed instruction" provided at no cost to parents that meet the needs of children with disabilities (34CFR300.26). The guidelines state this educational component should be offered in "the classroom, in the home, in hospitals and institutions, and in other settings" (34CFR300.26).

Additionally, part (b) (3) of these guidelines state the specially designed instruction is to be adapted to the needs of the child, and is to be designed in a way that "ensure(s) access of the child to the general curriculum, so that he or she can meet the educational standards within the jurisdiction of the public agency that apply to all children." (34CFR300.26).

Furthermore, section 300.551 of Title 34 indicates the states are required to ensure a continuum of alternative placements for children with disabilities that include provisions in such environments as listed in 300.26 (34CFR300.551). Section 300.552 lists specific criteria for such placement. These guidelines dictate that the placement of a child with a disability is made by a conglomeration of the parents, other individuals knowledgeable about the child, data relevant to the situation, and the possibilities for placement. Further, the decision for placement must be revised annually, be based on a program for success, be as close as possible to the home of the child, and be the best option for the child (34CFR300.552).

In addition to Title 34, Section 504 of the Rehabilitation Act of 1973 protects the rights of those with disabilities by stating that "no otherwise qualified individual with disabilities in the United States...shall, solely by reason of his/her disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program, or activity receiving federal financial assistance..." (20 USC, Section 794). According to the guidelines, a person can be considered disabled under one of three circumstances. First, an individual with a physical or mental impairment that substantially limits one or more life activities, including learning, hearing, walking, self-care, manual task completion, breathing and speaking can be considered disabled. Secondly, any individual with a record of such impairment can be considered disabled. Finally, anyone believed to have such impairment can be considered disabled. This category includes those with a physical or mental impairment that does not limit activity but is treated as a limitation, one whose impairment is only such because of societal attitudes, such as an obese individual, and those with no outward impairment, but a clear disadvantage, such as one with HIV (34 CFR, Section 104.3(j). In terms of education, Section 504 provides that schools who receive federal funding must provide a free and appropriate education in the least restrictive environment to students with physical or mental disabilities. Combined with Title 34, this means any disabled child must have an IEP (Individualized Education Program) designed by parents and teachers that ensures proper placement in the best possible educational environment for the student.

Finally, the Individuals with Disability Education Act (IDEA) provides that disabled students have a right to benefit from educational programs if between the ages of three and twenty-one. This statute is much more limiting than Section 504, in that it specifically states that disabled is defined as a child with "mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities" (20 USC, 1401 (3) a). Further, IDEA notes the disabling condition must result in a specific need for special education.

Section 504, on the other hand, broadened the criteria for special education services. By determining that a disability simply need limit a life activity, Section 504 allowed for services provided to children with such communicable diseases as AIDS, tuberculosis, temporary disability, such as short-term illness and injury, severe allergies, and other conditions. Further differences between Section 504 and IDEA can be found in Appendix a. It was the introduction of these additional definitions of disability that allowed states to begin providing homebound and hospital educational services.

General program and State by State requirements

In an effort to abide by these federal regulations, the Board of Education for each state developed a program for children who were temporarily unable to attend a regular school setting. Given such broad guidelines, each state has developed vastly different programs, with a wide range of options available. This section will discuss homebound and hospital education programs in general, as well as explain various state by state requirements.

In general, homebound and hospital programs are study programs designed to help students who are unable to attend school due to a medical condition to maintain their educational goals, and to progress normally in spite of their condition. In many cases, students participating in such programs are only temporarily disabled, due to injury, short-term illness, or other temporary issue. The instructor for such students adapts the curriculum in the student's normal classroom environment to enable those students to continue learning while dealing with their ailment. These services are not designed to replace regular school attendance, but rather, to provide a temporary learning environment when a student is unable to attend regular classes (Michigan Dept of Education, 2003). In this way, homebound and hospital educational settings provide the setting required by the federal guidelines for continued and appropriate alternative educational placement.

To qualify for homebound or hospitalized services, a student must be enrolled in a public school, and the district in which the student is enrolled is responsible for providing the content of the instruction, any materials required, assignments, instructors, and in determining the number of hours required each week. Further, each district is responsible for determining the number of days a student must be out of regular classes to qualify for homebound or hospital services. These qualifications can vary greatly between districts even within the same state (Michigan Dept of Education, 2003).

In general, the process for obtaining homebound or hospital services for a child is the same between the states. First, the parent or guardian must submit information from a physician, hospital, treatment facility, or otherwise qualified organization that determines the nature of the child's condition, the expected length of absence, and the possible limitations his or her condition may place on the activities, learning capabilities, and other health aspects of the child. In most states, these conditions may be medical, psychological, physical, or addiction based (Michigan Dept of Education, 2003).

Once the school officials have been notified of such a condition, many states require a meeting between the staff and the parents or guardian of the child to develop an IEP plan, and to determine whether the student qualified for special education under Section 504 or IDEA. This process is outlined in Appendix B. First, the determination is made as to whether the disability of the student limits a major activity, qualifying him or her for Section 504 aid, or if the disability adversely affects educational performance, which qualifies him or her for IDEA services. If eligible under Section 504, the student must be provided with services comparable to those of the disabled, including reasonable accommodations, physical and instructional material, specialized instruction, related aids and services, and a logical accommodation plan. If IDEA qualified, the district is required to provide specifically designed instruction and related services only, through an IEP plan. This plan is adapted to meet the educational needs of the student, and to create a plan by which the student can attain the highest level of education possible. Upon completion, the parents and staff agree to the terms of the IEP, and implement the plan (Michigan Dept of Education, 2003).

The states vary greatly in the determination for absences required before homebound or hospital services will be considered. In some states, the student need only be absent for a period of five consecutive school days before they are eligible for such services, such as in Florida and Kansas. Other states require two weeks of consecutive absences, such as in Alabama, New York, and South Carolina. Still other states, such as Nevada and North Carolina, require four weeks or more for eligibility for home instruction (See Appendix C).

In terms of providing instruction, the states vary greatly in their requirements. In some states, such as Alaska and Hawaii, the homebound or hospital instructors are not required to hold certified teaching certificates, but act as tutors alone. They obtain regular classroom materials from the student's regular instructor, and act as a tutor, delivering assignments and assisting the student in learning the material. In other states, such as New York and Texas, the individual responsible for providing instruction to the disabled student is required to hold a valid certified teaching certificate in the state of the services, and in some states, is even required to hold special education training certification (See Appendix C).

In terms of hours per week required for instruction, the states again vary greatly. In most states, at least 5 hours a week, equivalent to one hour per missed school day, is required for attendance to be considered adequate. Other states, however, have separate requirements for elementary and secondary students. In Delaware, for example, elementary students are required to have at least three hours of homebound or hospital educational service, while secondary students are required to have at least five hours per week. Still other states, such as Florida and Illinois, require one or two hours per week per subject, while others, such as Missouri and Pennsylvania, determine the hours needed based on the student's own educational needs (See Appendix C).

General Expectations of Teachers, Parents, and Students

While the specific state expectations for instructors, parents, and students involved in homebound and hospital educational service vary, many general expectations are shared between all states. This section will discuss the general expectations for all parties involved, and will outline the requirements for each party. By following general guidelines, the chances of student success are highly increased.

For the homebound and hospital instructors, the expectations are numerous. First, the instructor should contact the parent or physician to identify physical or learning impairments of the student, obtain a listing of limitations imposed by any treatments the student is undergoing, identify any extraneous factors that should be taken into account, and to determine any precautions needed to avoid the spread of communicable disease. Secondly, the instructor should contact the pupil's classroom instructor to identify subject and content areas to be covered. Third the instructor should meet with the student as determined by the school district, and should provide the needed assignments, support parents and caregivers to aid them in assisting the student's educational goals, provide tutoring to the student, and to provide other resources for support to the student to achieve maximum academic progress (Michigan Dept of Education, 2003).

The parent's responsibilities are also numerous. First, the parent must request homebound or hospital services, and provide all necessary medical information. The parent must also provide access to the homebound instructor, and be present during all sessions. They must provide an appropriate environment for assignment completion, and for educational sessions. The parents are also expected to assist the child as needed, and follow all instructions given by the homebound teacher. In addition, the parents of homebound or hospital schooled children should provide support to the student in terms of their academic achievement, but are expected not to perform the schoolwork for the child. If the parent feels the schedule, assignments, or level of education are too high or low, these issues should be brought to the attention of the IEP group or the homebound or hospital instructor (Michigan Dept of Education, 2003).

For the student, the expectations are similar to those within a regular classroom environment. The student is expected to ask for assistance when needed, and when clarification for assignments is required. Additionally, the student is to attend class activities, as possible, or to reschedule such sessions if illness or treatment prevents attendance. The student is also expected to return materials and supplies on time following completion of assignments, and to continue to work with their homebound instructor until such time as they are allowed back in a regular classroom environment (Michigan Dept of Education, 2003).

Supplemental materials

In addition to regular classroom materials, several states have begun to provide additional materials to homebound or hospitalized students in an effort to enhance their educational attainment. In Michigan, for example, staff is encouraged to utilize many technological tools in order to better educate students (Michigan Dept of Education, 2003). This section will discuss some of the supplemental materials used in various programs that can assist homebound students.

In cases of hospitalized education, some hospitals allow for full time instructional staff and classroom space for hospitalized students. In these cases, some districts allow schools to contract hospital services for the child, if the fees for such services are minimal, and parallel to the cost of a student in regular classroom environments. Such allocation of resources allows the district to contract services for students whose conditions endanger regular instructors, such as in the cases of communicable diseases (Michigan Dept of Education, 2003).

In some larger school systems, the use of telecommunications or video conferencing can be extremely useful for homebound or hospitalized students. In these cases, students who are physically capable of benefiting from instruction can be linked to the classroom via telephone communications or internet video. This allows the student to participate actively in classroom discussion, while still allowing the student to remain at home or in a hospitalized setting. While there are fees to set up such technology, many companies will wave these fees for special education situations (Michigan Dept of Education, 2003).

In terms of students whose disabilities involve hearing or vision limitations, there are numerous options. For some educational materials, publishers offer materials in a variety of forms, including video with subtitles, CD-Rom-based learning with audio cues, and books on cassette. For students whose limitations involve writing ability, voice activated computer software can easily take notes and record answers to assignments. In addition, the use of videos or computerized learning can enhance the student's education while providing an entertaining learning environment (Michigan Dept of Education, 2003).

Conclusion

There can be no question that long-term illness or injury can be devastating for a student's educational goals. However, as the federal guidelines specify, this does not mean the child is not eligible for the same educational services as those students without such conditions. Every state has implemented a homebound/hospital program for such circumstances, and all families are entitled to receive such services at no charge from their school districts. From the federal government's general guidelines to the specific requirements of each state, homebound / hospital educational programs continue to develop in an effort to maximize every student's educational achievement, regardless of circumstances. By working together, parents, staff, and authorities can ensure that every child is given the education he or she deserves.