Mind & Medicine - A Behavioral Health Podcast by Sentara
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Mind & Medicine - A Behavioral Health Podcast by Sentara
Working with the Education System - IEP, 504, and how Medical Professionals Can Help with Sid Wesseldine and Dr. Elizabeth Dixon
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Hello and welcome to Mind and Medicine, the Sentara Podcast. I am Tommy Bateman, your host, and today we'll be talking with Dr. Elizabeth Betsy Dixon and Sid Wesseldine about IP's 504 plans and what the medical professionals can do to help. Before we begin, here are a few important CME announcements. This episode is accredited for AMA PRA Category 1 credits for full accreditation, designation, and disclosure information, please refer to the show notes. And now the show. Sid and Betsy, thank you so much for joining us today. Before we get started, let's introduce ourselves. Sid, uh, why don't you get us started?
Speaker 2Okay, I'm Sid Wesseldine. I'm a special education advocate. Um, and I take a very collaborative approach working with everyone involved to help find solutions instead of create more problems.
SpeakerAll right, and Betsy?
Speaker 1Yeah, my name is Betsy Dixon. I have a PhD in counselor education supervision. I'm a licensed professional counselor. I currently am the clinical leader for the behavioral health navigators at Sentera.
SpeakerThank you. So tell me, what got you both interested in this particular topic? Uh, and so much so, Sid, that it's become your vocation.
Speaker 2Well, I'm a retired special education teacher. And um after I retired, um, you know, it it was great for a few months, and then I thought, you know, I need something to do. And uh former colleagues said, Hey, Sid, you're good with people, you know the law, you know IEPs. Um, why don't you become an advocate? So I thought, okay, yeah, I'll give that a shot. So I started out um 13 years ago, and I would have uh a couple of meetings a month, and now I have a couple of meetings a day, and I have three other people working for me. So it's it's a lot of fun, and I'm able to to help people, uh, which is is huge to me.
SpeakerThank you, sir. And and and Betsy, I know as a counselor, you've likely worked with children before, but uh what particular thing has gotten you interested in this topic?
Speaker 1Yeah, so I have four children, and all four of them have some sort of accommodations in place. Three have an IEP and one has a 504. I actually got my start in pediatrics at CHKD. And Sid was the advocate we used to refer families to, and I kept his card in my wallet for several years after I switched from CHKD to Centera, never knowing that I would need an advocate for my own child. And so that's how Sid and I know each other. He's worked with me for all four children.
SpeakerThank you. So to kick this off, tell me, what is a 504? What is an IEP? What's the difference?
Speaker 2The big difference is a 504 provides only accommodations. IEP provides accommodations as well as specially designed instruction. So the the basic difference is to qualify for a 504, you have to have a disability or a suspected disability and require uh you you have difficulty accessing the curriculum without accommodations. To qualify for an IEP is does the student require specially designed instruction? So if the answer to that is yes, then the student qualifies for an IEP. And that's the basic difference. Um to give you a specific example, if a student has been diagnosed with autism and has some uh social skin deficits and they have accommodations to be able to better express themselves to get along better with their classmates, um, they get a 504. So going back to the student with uh autism, if that autism is impacting them in that they are not able to express themselves to their teacher, to their classmates, and they need specific instruction in that area, qualify for an IEP.
SpeakerOkay, I see. So, well, here's the thing a parent goes to a doctor, gets a diagnosis, and the doctor says, All right, this child needs an IEP, or this this child needs some accommodations in the school. So uh help help me understand as a parent and as one in the field, why doesn't a diagnosis automatically mean you get the IEP or the 504?
Speaker 1Oh man, I can start this and then Sid can like seal it for me. But this is part of the reason I had to get hope with Cid or from Sid, because my second oldest son um was in kindergarten at, you know, at a public school. Um he is dual diagnosed. Um, he has ADHD and he's also profoundly gifted, but we didn't realize that when he was in kindergarten. And so he was a behavioral problem. And so I attempted to get the first just a 504 on my own. And because of the behavioral issues we were having, I knew he needed the IEP. But what the school tried to tell me is that you know, his grades were great, he's profoundly gifted. Um, he doesn't need any sort of support services, it's behavioral. And so that's when I reached out to Sid the first time because if you don't know how to specifically request what your child needs and how to navigate the language of IEPs and 504s, my personal experience with I think probably three out of four children is you're gonna get some sort of pushback.
Speaker 2Yeah, Betsy, I I agree. It might be more often than that, especially in the case where your your child is doing very well academically. That's where we go back to uh the schools and what the school is telling you. He's doing fine academically, he doesn't need an IEP. Well, what I explained to them not too patiently was that uh things like citizenship are graded and they're part of education. The other thing is if the student is constantly getting suspended because of behaviors that he has uh basically no control over, um then it's impacting his education. If he's not in the classroom, he can't get an education. You know, there are some cases where uh a diagnosis uh does basically automatically qualify a child, but still have to go through the process, look at what the weaknesses are, look at what the strengths are.
SpeakerAnd this may be the bad way of putting it, but why is there such a sense of resistance when it comes to schools giving 504s or IAPs?
Speaker 2I don't know that there's insistence, but one of the things that I explain to parents all the time is that there are times when the law, I guess, seems to be in your child's favor, and sometimes it appears to be working against them. That law is protecting the child. Um, it's not putting him or her in a special education classroom if they don't need the services.
SpeakerOh, I see. So uh the law has some say, but what about practical things like uh staffing?
Speaker 2First of all, there's a huge need for extensions in general, and then comes the special education, it's even worse. It can be very hard for me.
SpeakerVery hard indeed. And and so let's switch to the other side. Betsy, uh, you know, in the medical field, uh, we're often you know trying to figure it out from the outside. What are some things that you know we do on the healthcare side that we need to keep doing, or are there some things we need to stop?
Speaker 1I think the biggest barrier is lack of awareness on how families get help. And so from a like a physician standpoint, you know, they're trying to get patients in and out. They have, you know, a range of patients, um, acuity changes, and a lot of the SENTERA physicians, I feel like, you know, we see whoever comes through the door. And so I think one of the things that's helpful is what we're doing right now, which is educating them on IEPs and some of those fours. And then from a clinician standpoint, it's knowing your resources. And so if you see a pediatric patient and the parent is in the room and they're saying, you know, we're having all these problems in school, or I think my kid has ADHD, it's being able to link the parent, family, physician, whoever it is you're interacting with, with the appropriate resource and like being the bridge between starting the process of either getting diagnosed or getting that IEP in place.
SpeakerAnd Sid, has there ever been a time where a doctor wrote something that kind of hindered your goal or the family's goal? Or in other words, is there something that the medical field ought to do to really help make the case?
Speaker 2You know, I used to joke with Peter Dozier. I don't know if you ever knew I know. Yes. And and I used to joke with Peter, and I'd say, Peter, if you don't write any prescriptions for kids for IEPs, I won't write any prescriptions for uh psychotropic medications. So I never took offense by it. I knew that what the doctor was saying was this is what I think is best, and I understand that they're trying to treat the whole child. But what a better way to be would be to uh refer to the refer the parents to the special education system in their school district. Um, every school district is required to have a um parent resource center that is staffed by someone that is knowledgeable about the special education process that can help them. Um state has ombudsmen that can help them. There are other people like me, and I'm I'm I guess CNSK still maintains a list of advocates. To me, that's the best way. Again, be collaborative.
SpeakerAre there any disparities between you know rural or suburban versus urban uh you know access and of course delivery of the services?
Speaker 2Unfortunately, yes. In general, the more the area, the more difficult it is for the school division to staff speech pathologists and school psychologists are in more demand than special education teachers. And if somebody wants to live in a rural area and maybe 20 or 30 or 40,000 less as a speech pathologist than they'd make in this area, then great.
SpeakerBut um and so a school can have every good intention, you know, in following the law, but then practical realities can can limit the delivery of those services.
Speaker 2Exactly.
SpeakerOkay, so let's shift to uh accommodations in general. Um this is a broad way of putting it, but what what accommodations are we looking for? Um are there good ones, are there bad ones, useless ones? Uh what what should a parent really be asking for?
Speaker 1Oh man. I'll start just from a personal experience and then Sid can talk about broader. I think that's one of the most challenging things as a parent is I had no freaking idea what accommodations we needed. You know, in in the IP meeting, sometimes they'll even ask. And I feel like this happens more because I know I'm in the behavioral health field. They're asking me what works. And I'm like, I don't know what works. I need you to tell me what works. And so I mean, I think that's where it's helpful, even if you feel confident in your ability to navigate your child's disability and the MAP premises, like the accommodation specifically for our youngest son who just turned four and has his favorite dish. He has autism. And um, you know, I knew he was gonna qualify. However, he started early childhood spending at two. I had no idea what accommodations a two-year-old needed to be successful. And so Sid came to them, I think the he came to the first couple meetings just to make sure the accommodations were appropriate. And I remember specifically asking, there was like one goal, and I'm like, there's only one goal. This feels not appropriate. Sid was like, no, that's appropriate. So, you know, it's just a lot to navigate.
Speaker 2Yeah, um, and it's terrible to to to do that to parents. Um, you know, I I I feel so sorry for parents when I when I see that happen, but I I I prepare them. And um basically um the the the guiding factor is that uh is the present levels of performance, the plat-up as it's referred to, that is the centerpiece of the entire IEP. So if that is well written, then the rest of it is easy. And by well-written, uh kind of a rule of thumb that I give parents is that that section should paint a child picture of your child. Anybody that picks up that IEP should be able to say, okay, Tommy's son needs this, he can do this, he struggles to do this, he's very good at this, not so good at this. So for every need that is listed in that present level, there must be a goal and or accommodation to address it. So there's, you know, and people say, well, my kid has ADHD. Um what kind of accommodations should he have? And you know, I I tell him, well, that reminds me of what you get when you cross a rhinoceros with an elephant. Elephino. Um, you know, I don't know, because every kid with ADHD is different, just like the the you know, the trope about if you've met one person with autism, you've met one person with autism. Everybody's different. Um very often a student with ADHD has executive functioning skill deficits. So they will likely need support in note-taking, in organizational skills. Um other kids are, you know, the ADHD, the hyperactive type. Um, they can't sit in their seats, so they need to be able to take breaks. They might need a wiggle seat, they might need uh Theraband on their chair so they can bounce their foot off of it, they might need a fidget. Um other kids um are the inattentive type, so they might look like they're participating because they're sitting there quiet, but they need discreet redirection. It might be just a matter of uh Tommy the teacher watch it walking by and putting his hand on Susie's desk. And then Susie will look at you and Susie, do you need any help? Um, no, so you know, accommodations are very student specific.
SpeakerSo this reminds me of an episode I did uh a few episodes back with Chassity um about ADHD and women, and a lot of times uh these girls are falling through the cracks in the education system because their symptoms, you know, aren't high flying. They don't, I guess for lack of a better way of putting it, cause a problem in the school. So uh a two-part question for this: how do we identify those people that are struggling silently? And how do we get them into the system, into the IEP and the special education or the 504 system to get them the help that they need?
Speaker 2To me, the the the the students that fall through the crash most often are girls with autism. Um why um well I I go to the I I've attended the the the EBMS CHKD uh autism conference every year for the last 10 or 12 years, and they talk they have featured different times how autism impacts girls differently than boys. Um, I have a lot of girls with autism, um, and most of them were not diagnosed until middle school. Um, what very often one of the problems is that they talk about all the time is that ADOS uh way under diagnoses uh females with autism. Um and there are other assessment tools, diagnostic tools that are available that will do a better job of of diagnosing the girls. But the other thing is girls are for whatever reason seem to be much better at masking some of the things. And I think especially the girls that are like the level one that are really high, um they um very often their their biggest difficulties are in um the social skills, and you know, oh, she's just a quiet little girl, you know, she's very introverted, she doesn't say too much, but then when she gets and it happens all the time at middle school, once they get into middle school and those social demands are there, they fall to pieces a lot, very often. And I feel terrible for those girls. And um, you know, I've actually had uh I I have two girls that I one I'm still working with, but two girls that actually tried to commit suicide in school, in the school building.
SpeakerYeah, I have noticed uh some girls are diagnosed with anxiety early on, uh, maybe the the easiest and the uh a go-to diagnosis for that population when really there is some sort of executive function going on. But on the outside, they look anxious, they're you know, they're shutting down. Um, but they're not a behavioral problem in the class, right?
Speaker 2Right, right. Yeah, yeah. They're they're not a problem, you know. Uh uh, and you know, I've got uh I've got another girl that her mother just retained me. Um she was just diagnosed with autism, and she's a senior in high school. Um and you know, I I I went ballistic when I saw her grades because she started out in the IB program, still is in the IB program, but started out ninth grade first semester, all A's and B's, second semester, all B's and C's. The second year, start the year B's and C's, end the year C's and D's. Junior year, start C and D's, and straight E's. Why didn't somebody look at this kid? Why didn't an educator, why didn't a guidance counselor say, you know, this student has a need here? What's what's happening? Let's talk to this child. They didn't, and that was that that was to me just a tragedy. So now she's you. You know, digging herself out of a hole because nobody recognized that she had a problem.
SpeakerYeah, that's that's tough. And and Betsy?
Speaker 1Yeah. So I have an ADHD and I was not diagnosed until college.
SpeakerRight.
Speaker 1And so I struggled, but it's like Sid said, I was pretty well behaved, but I definitely have a distinct memory of standing in the corner repeatedly in second grade because my handwriting was messy. And it's because I was rushing. I just wanted to get it done so I could move on to the next. Um, and much like my son, I am, you know, I was in the, I don't know what they called it when I was in school, gifted and talented, right? And then in that school like honors and AP. And so I kind of flew under the radar. My grades were fine, they were decent. Um, but when I got diagnosed in college and started meds, it was like turning on a light switch. So I went from like struggling to make a B to making A's and then going on to grad school, graduating with the master's and then the DOC, both with a 4.0. And it was because of meds. Nothing else changed. And I did the doc with children.
SpeakerSo what do you think that schools wish healthcare providers knew? And then we'll go.
Speaker 1So having started as a baby out of undergrad teaching in the public school system for a few years, um, the demands on teachers, it's a different level of demand, but I would say it's the same level of demand, but different that is on a physician. And I feel confident in saying that because I've done both. Like I taught Title I it was incredibly hard. Um, and I've been in the hospital assistant since 2017, I think, maybe sooner. Um, and the level of demand is the same. And so I think, you know, doctors are like, well, the school should catch this. And the school's like, well, this is a medical professional. Why did they not catch it? Um, and so I think maybe having compassion, empathy for each other, and then also building that connection because when did doctors and teachers interact anyway? What's the likelihood of them even talking, right?
SpeakerExcellent. So, Sid, what do you think schools wish healthcare professionals knew?
Speaker 2You know, I I think that the it would be just an understanding, a better understanding of of how the system works and that they are the schools are not trying to stonewall and not give kids help. They want kids to succeed. Um and you know, I I think um that she we're talking about ADHD, especially. You know, if if you know a child is with a pediatrician space at a few minutes a year, if they're if they're healthy. Um they're in school a lot more minutes than that. So um the the problem comes in though, um, where you know I as a teacher could suspect that a child might have ADHD. But I was very limited in what I could say to the parent because I'm not qualified to diagnose that. So, you know, I would have to really couch it very carefully and say, you know, Mr. Bateman, um Susie seems to be off task quite a bit and not really paying attention. Have you ever noticed that? And you go, now that you mention it, yeah. Well, have you ever spoken to the pediatrician about it? Um, no, but I think that's a good idea, you know. Um, and and what on the other hand, there's parent, there's teachers that you know are not quite so subtle, and they go, you know what, Tommy, I think your kid needs to be on ADHD fence, you know. For real, they say that. Um, yeah, so uh, you know, so uh, you know, it's it's tough and it doesn't have to be adversarial, but both professionals are so busy in what they do, as Betsy said, you know, the teachers are busy, the doctors are busy. How do they collaborate? I mean, you know, when is the time to collaborate? I think that that the biggest thing to me would be if I could if I could give the health care and mental health care, physical and mental health care professionals something, it would be to direct the parents to the um parent resource centers within the within the school division. Um that would be a great place to start. Um and also um especially the pediatricians when the kids are younger, all the schools are required uh by state and federal law to have a child find program. And they have um educators at various resource fairs, uh healthcare fairs, and they're out there looking for kids um and trying to get them screened and to help locate those kids so they get the early intervention because they know it works. Um, but I I think the biggest thing would be um, you know, for the for the healthcare professionals to direct parents to that parent resource center that all the school divisions have.
SpeakerAnd Sid, I think you said something important there. You know, with everybody being as resource constrained as they are, the parent really has to take an active role. It can't just be the professionals in this case. And Betsy, I seem think that seems to match your experience.
Speaker 1Yeah, and I think that's another thing we see in both the school and the healthcare system. I notice it specifically in Sentera, and it breaks my heart. The parents don't realize there are resources like a preschool assessment center or that they need an IEP and they're trying to meet basic needs like paying the electricity bill or finding housing, or you know, they're working two jobs. And as I've navigated, so with parks with our four-year-old, as I've navigated like the autism process and like getting a waiver and getting Medicaid and all those things, like you have to find the inner dog within yourself. And what I tell other parents is I can't do it for you. You have to do it yourself. So, like, yeah, I can find sits, it can help me somewhat, but a lot of it is on the parent and if they're willing to fight for their child or not. And so I think that's the the parent being involved and willing to push if needed is imperative.
Speaker 2Yeah, and I I agree with you, Bessie. It I think a lot of times, and I'm sure you see it a lot, the parents don't realize that their child needs help. Um, maybe because they're just so busy, um, they're so tired, you know, they don't have anyone else to compare their child to. It's an only child and and uh they're seeing their child developing, um, and they seem to be developing okay, um, then they think they're okay, and then they get in school and all of a sudden they somebody says, Hey, you know, I think we need to do some testing here with your with your child.
Speaker 1Yeah. So my third child, we went into the preschool assessment center for speech. I thought he had a speech disorder, and they were like, No, he's actually delayed. And that's how we started ECSC, is they were like, you need a bigger evaluation. And I was like, he's fine. And he wasn't my first child. I'm like, he's fine. Like, there's nothing wrong with him. And when it came back that he had the developmental delay, I was like flabbergasted because I completely missed it.
Speaker 2So yeah, so it doesn't matter how well educated you are or um you know what what the circumstances are, it's it's easy to miss.
SpeakerSo in these final minutes, I want to give you both the opportunity. If the audience didn't hear anything, but this one thing, what do you want to leave with?
Speaker 2You know, I I think what I I would like to end on is that we all care about the kids, every one of us, or we wouldn't be doing what we're doing. Um and anything that we can do to better work together, to better educate our parents, to better support our children uh collaboratively is gonna be a plus. Um I I I don't know how we do that, but if we at least keep striving towards that, then I I think the world of special education and mental health and physical health will be a much better place.
Speaker 1I don't have anything to add, Tommy. That's well said. I would say we have to work together.
SpeakerYou've been listening to Mind and Medicine, a Sentera podcast. As a reminder, please check the show notes for details on how to claim your continuing education credits, as well as any resources mentioned in the episode. That's it for now, but keep an eye out for another episode and more evidence based education for healthcare providers on the go. You well.