• Abstract & Introduction
• Expanding Social Risk Factors
• Deteriorating Public Policy
  • Defining EBD
  • Welfare Reform
  • Mental Health Services
• Ineffective Educational Programming
  • Curriculum Issues
  • Management Issues
  • Placement Issues
  • Lack of Efficacy
  • Personnel Issues
• A Challenging Future
• An Advocacy Agenda
• References

Many of the negative conditions described above are both the result of, and the cause of, larger policy decisions. For example, the question of which students can receive special education services has long-reaching implications for successful outcomes. Those students deliberately prohibited from receiving special education services because they exhibit disorders of conduct (as specified in the current, but defective, IDEA definition [Federal Register, 1981]), become increasingly problematic for the schools. These increasing numbers of anti-social youth (who exhibit anti-social behavior partly because no effective educational and mental health treatment has been provided) have prompted recent state mandates to deny education to aggressive youth, or for the relegation of these students to separate campuses (kiddy jails). By refusing or reducing educational services to aggressive children and youth as a matter of policy, society is forced to develop new policies to deal with them, policies that are increasingly punitive. While in general, children and youth with, or at risk of, EBD are not direct targets of educational and social reform legislation, the subsequent impact on their lives is profound.

There is general agreement that the current definition used to qualify students for services under the label of "seriously emotionally disturbed" is flawed. Its vague criteria create problems in accurately identifying students who need special education services for emotional or behavioral problems. The social maladjustment exclusion clause allows districts to keep many students with conduct disorder out of special education (and thus away from its attendant protections with regard to discipline and service delivery). These are students who may well benefit from the curriculum, structure, individualization, and behavior management strategies tailored for students with EBD. At the very least, the exclusionary clause keeps services away from many students in need. It is estimated that 7% to 10% of the school-aged population need special education services for EBD, yet less than 1% are currently being served (Tompkins, 1996). At best, the exclusionary clause creates inconsistency because many students who are maladjusted socially have received services under a severely emotionally disturbed (SED) label.

The most recent definition proposed by the National Mental Health and Special Education Coalition (Forness & Knitzer, 1992) addresses many of the shortcomings of the existing definition. The proposed definition:

• Describes disorders of both emotions and behaviors, and therefore more accurately reflects the types of students currently being served in EBD programs and the types of students who could benefit from services.
• Assures better diagnostic reliability by addressing age, cultural, and ethnic considerations.
• Expands the notion of educational performance by including social, vocational, and personal skills in addition to academic achievement thus making it more likely that students in need will qualify.
• Increases the likelihood of interagency collaboration by including both mental health and education terminology.

While there is strong support for the new definition within the field of EBD, several educational groups (e.g., Council of Administrators of Special Education), driven by the "push out and save money" mentality, have mounted stiff opposition to any change in the definition. Some proponents of the new definition believe the lobbying power of these groups is sufficiently strong to reduce the likelihood of the new definition being accepted and incorporated into the Individuals with Disabilities Education Act (IDEA) to a 50-50 change (Morse, 1996). Sadly, opposition to the proposed definition appears to be based on politics and economics rather than sound theoretical or conceptual arguments (Simpson, 1996).

The welfare reform package signed into law in 1996 has widespread implications for children with EBD and their families, both directly and indirectly. it is estimated that, as a result of that bill, an additional 1.1 million children will fall below the poverty line (Bazelon Center for Mental Health Law, 1996b). As Hugh Price, president of the National Urban League, summarized, it is evidence "that Congress has wearied of the war on poverty and decided to wage war against poor people instead" (Hugh Price, president of the National Urban League, as cited in Herbert, 1996). Furthermore, if "…the President, Congress, and the American public are willing to act callously toward poor children, how soon will it be before a backlash develops against children with disabilities?" (Editorial, 1996). According to the Bazelon Center for Mental Health Law (1996a), some of the more dramatic aspects of this reform, as it affects children with disabilities, particularly those with mental health needs, include the following:

• Despite the traditional view that stay-at-home mothers provide the best environment for the development of their children, the Personal Responsibility and Work Opportunity Reconciliation Act ends the entitlement of low-income women and children to Aid for Families with Dependent Children (AFDC), thus forcing poor mothers into the workforce and their children into, perhaps questionable daycare and/or unsupervised situations. Most individuals who receive welfare benefits must work after 2 years or lose their benefits, and they can receive benefits for no longer than 5 years during their lifetime, perhaps relegating poor children to even more dire circumstances
• The law stipulates major cuts in food stamp programs, child nutrition programs, child care, and social services, thus removing the safety net for many children with disabilities.
• The bill results in a $8.2 billion reduction in the children’s Supplemental Security Income (SSI) program and tightened eligibility requirements for SSI benefits. To qualify, children must have medically-determined impairments. This narrowed definition of childhood disability may result in 315,000 children losing or being denied access to benefits over the next 6 years. Furthermore, the limitation of a functional determination of disability (i.e., the extent to which the disability impairs daily activity as compared to nondisabled age peers) for SSI in favor of the more restrictive medical determination is especially detrimental to children with EBD who constitute 44% of all children who now qualify for SSI through functional assessment.
• There will be a reduction in the number of people with disabilities who qualify for Medicaid (up to 50,900 will lose eligibility). For example, children who will no longer qualify for SSI will not be eligible for Medicaid unless they are eligible on other grounds (e.g., family income).
• Legal immigrants are no longer eligible for welfare or nonemergency Medicaid benefits for the first 5 years they live in the U.S., entirely removing financial and medical support for large numbers of children.
• Despite the law’s emphasis on work, the Congressional Budget Office estimates the welfare law is $13 billion short of the amount needed to create jobs and $1.4 billion short to provide child care for welfare families (Bazelon 1996b).

These reforms, it appears, are not based on valid assumptions. Assuming that those receiving welfare benefits need to work ignores the fact that almost half already work but remain desperately poor (Bazelon, 1996b). Now state policymakers are faced with decisions regarding the implementation of welfare programs with less money. They will find that many of their state’s most vulnerable families will find it more difficult to meet basic needs including feeding their children, can no longer rely on Medicaid to cover costs of mental health services and child care services will struggle to find appropriate child care, may be at risk from an abusive adult because of the requirement that women cooperate in establishing paternity and assist the state in recovering child support, and will receive less support overall because of constraints on state systems (Bazelon, 1996b).

How do these changes affect students with EBD in your school? Do any of the families of these children receive SSI? They may not be eligible in the future. Does Medicaid cover medical expenses and mental health services, including medication, for any of your students? It might not in the future. Are any of your students legal immigrants? They may soon be cut off from most sources of financial assistance.

Although most of us expected the worst from the 104^th Congress whose agenda was to cut programs assisting low-income people and people with mental and physical disabilities, the results were not all negative. Some positive action was enacted concerning parity in private insurance coverage of mental illness and increased funding for mental illness and increased funding for mental health programs (Bazelon, 1996a). Legislation was passed that mandates parity in private insurance coverage for mental health care in lifetime or annual reimbursement caps. Although this mandate only pertains to employers of 50 or more, does not take effect until 1998, and sunsets in October 2001, it is still a positive indication that Congress considered mental health needs to be as valid as physical needs. The best news is that Congress increased mental health appropriations for the coming fiscal year. Funded programs include comprehensive community service programs, federal demonstration programs for child and adult services, substance abuse block grants, and the protection and advocacy program for persons with mental illness. Perhaps these are signs that the punitive tide is turning.

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