A Guide to Educational Services for Ill and Disabled Children

I. Introduction

Having a child sick or disabled and in a hospital is an overwhelming experience for most parents or guardians. The education of a child while in the hospital often takes a backseat to their immediate medical needs, however it is important to remember that school districts are required to provide services for children over the age of three who are hospitalized or are too sick to attend school. The extent of services school districts are mandated to provide varies depending on each child’s needs, and so it is important for parents or guardians to be educated on the continuum of services available to them to insure their child receives all that are afforded to them by federal and state laws. As providing these services costs school districts extra money, sometimes parents will encounter school or district employees who will be resistant to providing extra services for their children. While it is important for a parent to try to maintain a positive relationship with those school employees who will be working with their children, they also need to remember that it is your local, state and federal tax dollars which are sustaining their school and that their child is entitled by law to certain rights.

II. Home/Hospital Tutoring Services

A. Examples of Situations Requiring Home/Hospital Tutoring

A child may require home/hospital tutoring if he or she exhibits any of the following medical needs:

– Long-term (lasting more than 10 days) hospital stay

– Illness resulting in long-term home stay

* It is important to note that medical needs may not be the only reasons for hospital or home stay – if a child is experiencing psychological or psychiatric issues (i.e. cutting, suicidal ideation, homicidal ideation, depression, anxiety, etc.) related to attending school, then they are also eligible for home\hospital tutoring services.

B. Requirements of Districts to Provide Services

1. Doctor’s note

According to state law, school districts require a physician’s note stating that the child requires an absence from school for at least 10 days, and requires home/hospital tutoring services. Once that note is received, tutoring services can begin immediately.

2. Number of Hours Per Day

School districts are only required to provide one hour per day, or, at a minimum, five hours per week of tutoring services. However, they can provide up to five hours per day of services, if they want to. Should your child be too ill as to handle five hours per week of tutoring, then the district can provide less than five hours but only if a physician’s note allows it.

3. Related Services

A school district is not mandated by law to provide related services (i.e. speech-language therapy, occupational therapy, physical therapy, social work services, etc.) during your child’s homebound placement.

4. Teacher certification

Under the current Illinois law, a teacher providing home/hospital tutoring must hold a valid teaching certificate in order to provide services. However, that certificate does not need to be held in any specific area, nor does the teacher need to be “highly qualified” as defined by the No Child Left Behind Act (“NCLB”). A person with a Type 39 (substitute teacher) certificate is not authorized to provide these tutoring services.

C. Impact on attendance and credits

This section applies primarily to high school students. State law requires districts to provide counseling services “based on a child’s needs,” and if a child requires tutoring services over a long period of time or if their length of stay at a hospital could impact a student’s graduation requirements, then the district is obligated to provide equitable services which would enable that student to meet those requirements. For instance, if a high school student is taking a lab course (biology, physics, etc.) at the time, then the state recommends that the district modified that child’s curriculum so that a student can meet graduation requirements without fulfilling the lab portion of the class.

In addition, districts are required to provide home/hospital tutoring in the summer should the child require the work to move up to the next grade. There is one caveat – the district is only required to provide summer tutoring when school is regularly in session, so if the district’s regular education summer school only lasts for four weeks, then it is only required to provide tutoring for that same timeline, i.e. to the extent provided for nondisabled students.

Regarding attendance, every hour that a child receives home/hospital tutoring services will be counted as half day in the regular school. In order for the district to be able to count a child as attending a full day during this period, they must provide 4 hours of tutoring instruction.

III. Section 504 Services and the ADA

A. Definition and Purpose of Section 504 and ADA:

The term “Section 504 Services” relates to a section of the Rehabilitation Act of 1973, a law created to protect the civil rights of disabled persons. Section 504 specifically pertains to federal and state agencies which receive federal funding, and prohibits these agencies from discriminating against any adult or child with a disability.

The term “ADA” refers to the Americans with Disabilities Act, which provides exactly the same protections as Section 504 of the Rehabilitation Act, however it expands the law to all agencies, regardless of whether that agency receives federal funding.

With regard to students, these laws insure their right to “equal access” to education and requires school districts to provide modifications and adaptations to the physical school environment to allow students to access the same education as a child without an illness or disability.

B. Examples of Children Who Would Be Protected Under Section 504 and ADA

The most common examples of children who would be protected under these laws pertain to children with physical or mental disabilities which “substantially limits… one or more… major life activities[1].” Examples include children with severe allergies or asthma, Acquired Immune Deficiency Syndrome (“AIDS”) or Attention Deficit Disorder (“ADD”). In order for these students to be provided the same education as their non-disabled peers, they may require modifications or accommodations to the classroom or school atmosphere, including nursing services, extra time for completion of assignments, quizzes or tests, the allowance of breaks throughout the school day, the ability to carry a water bottle or snacks throughout the school day, a waiver from physical education, etc.

C. Differences Between Section 504/ADA and Individuals with Disability Education Improvement Act (“IDEIA”) Protections

1. Eligibility Requirements

With regard to eligibility for Section 504 (described in more detail above), a child can be found eligible for these services if they have a physical or mental disabilities which “substantially limits… one or more… major life activities.” In contrast, for a child to be found eligible for full special education services under the IDEIA, their disability has to be to such a degree as to “adversely impact educational performance.” This qualification is harder to prove, and as such limits the number of children eligible for special education to the most severely disabled.

2. Access versus Educational Benefit

Section 504 and the ADA provide mandates that school districts merely provide accommodations and modifications to insure children with disabilities have equal access to education. However, they do not mandate that children being served under a Section 504 Plan actually benefit from those interventions.

However, under the IDEIA, a child is entitled to an Individualized Education Plan, (“IEP”) which is drafted to meet each child’s unique needs and allow them to benefit educationally from those services in order for them to become as independent as possible as an adult. However, the law states an IEP is neither a guarantee nor an enforceable contract.

3. Procedural Safeguards

There are extensive procedural safeguards offered to children who are being served under Section 504 and the IDEIA to prevent school districts from changing or discontinuing services without parental involvement. The IDEIA allows for far more detailed procedural safeguards should the district not be providing appropriate services. These safeguards include districts having to provide written notice to parents prior to changing or altering a child’s special education services or placement, the right to an independent educational evaluation at district expense, the right to reimbursement for a private school placement should the district not provide appropriate services and the right to a formal due process hearing (similar to a trial) should the district not provide appropriate services.

4. Discipline

For children being served under Section 504 and IDEIA, there are protections against the school district taking extreme disciplinary actions against that student, including suspension or expulsion. For children eligible for special education services under the IDEIA, prior to a district suspending a child for more than 10 school days or expelling a student, they must hold a meeting (called a manifestation determination) including the parents to discuss whether the student’s actions were related in any way to their disability. If the team finds that the actions were related to the child’s disability, then the district is prohibited from disrupting special education services and must provide additional services in order to prevent future disciplinary incidents.

IV. Special Education Services

The first law enacted to enforce school districts to educate children with disabilities was the federal law entitled the Individuals with Disabilities Education Act, first enacted in 1975. Since that time, the law has been revised twice, with the most recent reauthorization being done in 2004 (which went into effect on July 1, 2005). The IDEIA sets the standards for school districts to provide a term called a Free and Appropriate Education (“FAPE”) to all children in the Least Restrictive Environment (“LRE”), meaning that, if appropriate, a disabled child must have access to the regular education curriculum and environment as much as possible.

A. Eligibility Categories and Definitions:

A child can be found eligible for special education services under one of thirteen categories as defined by the Illinois special education regulations (23 Ill Admin 226.75), which includes the following:

Autism: A developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance. (A child who manifests the characteristics of autism after age 3 could be diagnosed as having autism if the other criteria of this Section are satisfied.) Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance.

Deaf-Blindness: Concomitant hearing and visual impairments, the combination of which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness.

Deafness: A hearing impairment that is so severe that the child is impaired in processing linguistic information through hearing, with our without amplification, that adversely affects a child’s educational performance.

Emotional Disturbance: (includes schizophrenia, but does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance): A condition exhibiting one or more of the following characteristics over an extended period of time and to a marked degree that adversely affects a child’s educational performance:

An inability to learn that cannot be explained by intellectual, sensory or other factors;

An inability to build or maintain satisfactory interpersonal relationships with peers and teachers;

Inappropriate types of behavior or feelings under normal circumstances;

A general pervasive mood of anxiety or unhappiness or depression; or

A tendency to develop physical symptoms or fears associated with personal or school problems.

Hearing Impairment: An impairment in hearing, whether permanent or fluctuating, that adversely affects a child’s educational performance but that is not included under the definition of deafness.

Mental Retardation: Significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a child’s educational performance.

Multiple Disabilities: Concomitant impairments (such as mental retardation-blindness, mental retardation-orthopedic impairment, etc.), the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments (does not include deaf-blindness).

Orthopedic Impairment: A severe orthopedic impairment that adversely affects a child’s educational performance; includes impairments caused by congenital anomaly (e.g. clubfoot, absence of some member, etc.), impairments caused by disease (e.g. poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g. cerebral palsy, amputations, and fractures or burns that cause contractures).

Other Health Impairment: Limited strength, vitality or alertness, including a heightened sensitivity to environmental stimuli, that results in limited alertness with respect to the educational environment, that:

Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and

Adversely affects a child’s educational performance.

Specific Learning Disabilities: A disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or do mathematical calculations, including such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. (The term does not include learning problems that are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage.

Speech or Language Impairment: A communication disorder, such as stuttering, impaired articulation, a language impairment, or a voice impairment, that adversely affects a child’s educational performance.

Traumatic Brain Injury: An acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a child’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual and motor abilities; psychosocial behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative or to brain injuries induced by birth trauma.

Visual Impairment: An impairment in vision that, even with correction, adversely affects a child’s educational performance (includes both partial sight and blindness).

B. Early Warning Signs for Disabilities

It is not uncommon for parents, many of whom are raising a child for the first time, to be uninformed about the warning sings of potential disabilities in their children. Adding to this could be school personnel, on whom the parents rely for advise and consultation regarding their children’s educational performance, informing parents that their children are “doing fine,” or “eventually they’ll catch up,” when in fact their child actually has a learning disability which will only worsen in the years to come.

Below are some of the most common “warning signs” for parents to watch out for during their child’s emotional and educational progress throughout elementary, junior and senior high schools.

· Missing any major developmental milestone:

Babbling – 12 months
Gesturing (point, wave, grasp) – 12 months
Walking (without support) – 15 months
Speaking – single words – 16 months, 2 – 3 word sentences – 24 months
Kick a ball – 36 months
Matching objects – 36 months
Writing name and drawing circle – age 4
Catch a bouncing ball – age 4
Recognizing colors – age 4
Separate from parent for short time without crying – age 4
Reading – age 6

· Difficulties in any of the following areas in elementary school[2]:


  • Slow learning of correspondence of sound to letter
  • Consistent errors in reading or spelling
  • Difficulty remembering basic sight words
  • Inability to retell a story in sequence
  • Trouble learning to tell time or count money
  • Confusing of math signs
  • Transposition of number sequences
  • Trouble memorizing math facts

Motor Skills

  • Poor coordination or awkwardness
  • Difficulty copying from chalkboard
  • Difficulty aligning columns (math)
  • Poor handwriting


  • Difficulty concentrating or focusing on a task
  • Difficulty finishing work on time
  • Inability to follow multiple directions
  • Unusual sloppiness, carelessness
  • Poor concept of direction (left, right)
  • Rejection of new concepts, or changes in routine

Social Behavior

  • Difficulty understanding facial expressions or gestures
  • Difficulty understanding social situations
  • Tendency to misinterpret behavior of peers and/or adults
  • Apparent lack of “common sense”
  • Difficulties in any of the following areas in secondary school:

Language/Mathematics/Social Studies

  • Avoidance of reading and writing
  • Tendency to misread information
  • Difficulty summarizing
  • Poor reading comprehension
  • Difficulty understanding subject area textbooks
  • Trouble with open-ended questions
  • Continued poor spelling
  • Poor grasp of abstract concepts
  • Poor skills in writing essays
  • Difficulty in learning foreign language
  • Poor ability to apply math skills


  • Difficulty staying organized
  • Trouble with test formats such as multiple choice
  • Slow work pace in class and in testing situations
  • Poor note taking skills
  • Poor ability to proofread or double check work

Social Behavior

  • Difficulty accepting criticism
  • Difficulty seeking or giving feedback
  • Problems negotiating or advocating for oneself
  • Difficulty resisting peer pressure
  • Difficulty understanding another person’s perspectives

Emotional Behavior

  • Loss of interest in previously fulfilling subjects
  • Increasing numbers of unexplained absences or tardiness
  • Heightened emotional reactions, social withdrawal or unexpected changes in mood (rapidly angry or sad)

Some other general warning signs to look for in your children are:

  • If they say they hate attending school
  • If they come home from school exhausted and cranky, and refuse to complete homework

C. Process of Initial Eligibility for Special Education Services

If your child is suspected of having a disability which would make them eligible for services within their local school, there are a number of steps which need to be taken prior to receiving those services. The process can be extremely daunting, mostly because of the amount of paperwork involved, however being educated on the different steps of the process can help a parent feel more comfortable and in control.

1. Case Study Evaluation:

The first step in any case is to formally refer the child for a Case Study Evaluation (“CSE”), which is a comprehensive set of tests which your school district conducts in order to pinpoint your child’s areas of strengths and weaknesses in order to know which services they should be receiving.

There are eight “domain” categories of testing, which include: health, vision, hearing, social/emotional status, general intelligence, academic performance, communication status and motor abilities. Depending on your child’s needs, one or more of these tests may be waived in order to expedite the process. However, it is important to remember that as a parent you are part of the educational team for your child, and have the right to challenge your school district, should you feel a decision is not being made in your child’s best interests. More information will be provided later in this article regarding the rights that you have as a parent and avenues you may seek should you and your school district disagree on any of these items.

2. Individual Education Programs:

After a CSE is completed, the school district will need to meet at an Individualized Education Program (“IEP”) meeting to determine if your child is eligible for special education services. If the team (which remember, includes you as a participant) determines that your child is not eligible for special education services, then the team may talk about providing Section 504 accommodations (see above for details) or no services at all.

Should the team find your child eligible for special education services, then the team will review and create your child’s IEP, a lengthy document which is created to provide them with an individualized education according to his/her specific needs. The major sections of the IEP include: 1) goals for your child, 2) educational accommodations and supplementary aides, 3) educational placement and related services (which could include speech-language services, occupational therapy, physical therapy, social work services, etc.), and 4) transitional services (which are geared toward older children in preparing them to transition out of the education system).

D. Annual reviews:

After a child is found eligible for special education services, a district is then obligated to conduct annual reviews of that child’s progress to insure they are gaining educational benefit. These progress checks are IEP meetings called “annual reviews,” and are most often held near the end of a school year.

With IDEIA going into effect on July 1, 2005, there has been a change in the requirements for school districts to hold these annual reviews. Prior to this law, school districts were required to provide quarterly progress reports to parents, which included information about how the child was progressing toward their short-term goal benchmarks. However, with the passing of the new law, districts are now only mandated to provide this information on an annual basis. However, the law continues to provide that parents can request an IEP meeting at any time to discuss the progress of their child.

E. Educational Placements:

Depending on your child’s disability and their individual needs, there are a variety of educational interventions available to them, both within and outside of their homeschool or local school district. The IDEIA does specifically mention that children with disabilities should be educated in the least restrictive environment (“LRE”) possible, meaning that they should be mainstreamed as much as possible in order to benefit socially and educationally from interaction with nondisabled children.

However, in some cases a child’s disability is so severe or complex that placement outside a regular education environment is necessary in order for them to receive appropriate educational benefit. In most cases, these children require teachers who are specifically trained as special educators, and most often who are experienced in working with children of certain disability categories.

The continuum of placement options available to your child pursuant to Federal and state law, depending on their educational needs, include: (listed from least to most restrictive)

  • regular education environment with modifications and/or related services only
  • special education resource classroom (less than 50% of the day)
  • self-contained special education classroom (more than 50% of the day)
  • private special education day school
  • private therapeutic residential school

While these are the five most common placement options discussed at IEP meetings, there are other options, varying from district to district, which are also available to parents. While some school districts may not offer special education classroom which are appropriate within their local school buildings, nearly all school districts are affiliated entities called special education cooperatives, which provide additional services and placement options for districts for children. Some of these cooperatives run their own special education schools, and would be provided as an additional option for parents. In addition, districts also are mandated to provide home/hospital tutoring services (see above for more details) when a child is ill or unable to attend school, and sometimes will agree to placing a child within a particular special education program or classroom within a different school district should it be appropriate for the child. The important thing to remember is that each child found eligible for special education services is granted an “individualized” educational program, and so working with your local school district to find a good classroom or program fit for your child is extremely important.

F. Advocacy and Due Process:

As with your child’s health and medical issues, it is important for parents to become educated about their child’s rights and the school district’s responsibilities related to providing special education services. As it is more expensive to educate a child with a disability than a regular education child, some school districts are hesitant to provide services for children.

However, the IDEIA sets forth a number of procedural safeguards for parents in order to insure that their child is receiving a free and appropriate education. Some of these procedural safeguards include:

  • Requiring written notice from the district and parental consent prior to change in special education eligibility, services or placement;
  • Requiring written notice and parental consent for the initial evaluation or re- evaluation of their child;
  • The right to an independent educational evaluation should a parent disagree with the evaluation conducted by the local school District;
  • Reimbursement for the cost of a unilateral private special education placement, should the district’s proposed placement not be appropriate for the child;
  • The right to a Manifestation Determination Review (“MDR”) should a child with a disability be recommended for an extended suspension or expulsion from school;
  • The right to a due process hearing (which is much like a trial) should a parent disagree with the proposed IEP or placement of their child.
  • The right to inspect, review and copy their child’s educational record and request that items within the educational record be changed or removed should they be erroneous.

In addition to these safeguards, parents are allowed to bring with them medical experts, educational advocates and/or education attorneys to IEP meetings for support. For most parents, navigating the world of special education is an overwhelming experience, closely related to one of the most important things in their lives – their child’s future. It is extremely difficult for some parents to pay attention during IEP meetings to all the information that is being offered to them by school districts, take notes and attempt to keep up on whether the district personnel is doing things “by the book,” at the same time. Sometimes taking someone with you – even a relative or close friend who can take notes and help you maintain your focus in one direction – can be extremely helpful to insuring your child receives the education he or she deserves.

We offer these “Top Five Advocacy Tips for Parents” which you may find helpful at your next IEP meeting.

1. Just As Your Child Is Asked To Do, Do Your Homework! – Learn your rights prior to going to an IEP meeting or any meetings with district personnel. Know the law and know the special education terminology. The ISBE parent’s rights handbook and the ISBE website are both good places to start. Our website at http://www.whittedclearylaw.com/ provides many free publications and links to other websites. There are also multiple seminars, such as Wrightslaw, that parents can attend. Also, the Family Resource Center in Chicago provides free training sessions. School district personnel usually respond more positively to parents they perceive as informed, interested and involved;

2. Organization Is Your Friend – There is nothing wrong with drafting up a list (typed preferably) of issues you would like discussed at your child’s IEP meeting. Make copies for each member of the team. Ask the district to address all of the issues on the list in addition to the agenda items the district needs to get through. Keep in mind number three below though;

3. Stay Focused, (in the words of a great law professor) Be Brief, And Be Realistic!!!! – The most common mistake we see from parents who have reached impasse with a school district is that they try to accomplish too many things at one time. Similarly, some parents will write the school district rambling, lengthy letters replete with 42 issues to which they want responses. Not only does this strategy water down your main issues, but, many school district personnel are not going to provide the level of detail you want. (I’d be surprised if they even get through half the letter). Parents need to determine what they really want. Other issues can be brought up at a later time; you don’t have to worry about waiving them. In addition, parents can request IEP meetings at anytime they determine that there are issues to be discussed (within reason – most hearing officers will think four meetings a month is unrealistic). Finally, regarding realism – most parents want the “Cadillac” for their child; what parent wouldn’t? However, the Supreme Court Case, Rowley, tells us that they are only entitled to a well running “Chevy.” In line with keeping your issues focused, be realistic about what you are asking for, and, for that matter, what your child can handle within the school setting. One of the best ways to do this is to utilize experts, as we discuss in number four, below;

4. Paging Dr. Somebody: Use Reputable Experts – The law clearly allows parents to obtain their own private evaluations at their own expense and districts have to consider the information at an IEP meeting. The law also mandates that school districts pay for the evaluations in certain circumstances, but we always advise parents to spend the money if possible, as it keeps them in control. Use reputable experts who have experience dealing with school districts. Ask any intended evaluator if they will accompany you to an IEP meeting to discuss their recommendations with the school district. Any expert who will not go to IEP meetings is not one that you want to waste your money on. Any evaluation you obtain should be comprehensive and should provide clear recommendations that can be implemented in the school setting. We also recommend using experts who know education placements for parents who are encountering placement disputes with their districts to conduct observations of proposed programs; AND FINALLY

5. Don’t Ever Let Them See You Sweat! In Other Words, Do Not Be Intimidated! – The IEP teams may at times become voluminous and seem to hold fancy degrees, but who knows the child best? Hopefully the parents! Parents should listen to the educational team, consider their recommendations, but should not be afraid to disagree with any team member. With that said, always be as kind and cooperative as possible. I have seen more parents get what they want with kindness and respect than by being rude and aggressive. District personnel are people too and, like most people, they likely won’t respond well to insult or threats. Parents may become angry that district personnel are disagreeing with them but they should always stay civil. In addition, many people, including the best lawyers, become unfocused when blinded with anger. The more calm and civil a parent, the more likely they will think clearly.


[1] Examples of “major life activities” include walking, seeing, hearing, speaking, breathing, learning, reading, writing, performing math calculations, working, caring for oneself and performing manual tasks. (Wrightslaw: Discussion of Section 504, the ADA and the IDEA, www.wrightslaw.com/info/sec504.summ.rights.htm)


[2] This information taken from “The Warning Signs of Learning Disabilities,” ERIC Digest #E603, by Susan Bergert, December 2000, http://www.tourettesyndrome.net/.