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PLUK News October/November 1998 Volume 13 Number 3/4
	PLUK News is published by Parents, Let's Unite for Kids, a private nonprofit organization founded in 1984 by a group of parents of children with disabilities and chronic health problems. Subscriptions are free, however, we ask that subscribers contribute $15/year toward PLUK activities. PLUK News is available in alternative formats. Editor: Katharin A. Kelker Production: Roger Holt PLUK Office 516 N 32nd St Billings MT 59101 800.222.7585 in MT; 406.255.0540 (voice/TT); 406.255.0523 (fax) E-mail: plukinfo@pluk.org
The contents of this newsletter were developed under a grant from the Department of Education. However, those contents do not necessarily represent the policy of the Department of Education and you should not assume endorsement by the Federal Government. Products and services described herein are not endorsed by PLUK, the U.S. Department of Education, or by the Federal Government.

Article Index

Is Your Child 14 Years Old? Agreement Reached on Federal Budget School Administrators Lobbied IDEA Regs Expected New Speaker for House Supreme Court Hears SPED Case Congress Sunsets AT Program Good News About Medicaid Coverage Head Start Reauthorized Montana's Budget Proposed Resolving Conflict: EAP The Legislature is Coming! Montana to Receive $5.6 Million Services for Deaf Blind Children Managed Care Continues Handling the Holidays Happily Parent Support Volunteer Network Draft Policy on Aversive Treatment CEC Conference in March

Items for Sale ASK PLUK??? Parent Corner 50 Tips for Coping w/Mental Illness Hints for Making Tough Decisions Handling Crises Tips for Handling Tough Conversations Parent Reports on TS Conference When to Call the Doctor Volunteer Opportunities at PLUK Remediating Sensory Processing Deficits ADD "Major" Problem Prenatal Nicotine Exposure & ADHD Is ADHD Overdiagnosed? Frontal Lobe Injury or Dysfunction Risperdal & Autism Risk for Drug Abuse HONOR ROLL

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Is Your Child 14 Years Old or Older? Does Your Child Have a Transition Plan?

IDEA '97, the reauthorization of the federal special education law, requires every student in special education to have a statement of transition services written into the IEP when the student is 14. The purpose of this requirement is to focus attention on how the child's educational program can be planned to help the child make a successful transition to life after secondary school. This provision is designed to augment, and not replace, the separate transition services requirement under which children with disabilities, beginning no later than age 16, receive actual transition services (e.g., linkages to adult service agencies).

A statement of transition services means a written explanation of the skills the student needs to learn in order to prepare for transition. Statements will vary according to the type of outcome projected for the student. For example, some students will plan to enter college after high school, but will need to learn compensatory skills like word processing or screen reading in order to be prepared to do college level work. Other students will want to learn employment skills by taking vocational courses as part of their high school program. Others will need to work on independent living skills (e.g., cooking, cleaning, budgeting, time management) to prepare them for living on their own in the community. In any case, there should be a complete statement in the IEP of the types of courses and activities necessary for the student to be prepared for transition from high school into postsecondary education, employment, or other adult occupations.

PLUK's Commitment

Over the next two years, Parents, Let's Unite for Kids (PLUK) is going to dedicate its efforts to helping all parents of special education students aged 14 and older to make certain that their child's transition needs have been addressed in the IEP. It doesn't matter what disability that the student has--learning disabilities, emotional disorders, cognitive delays, sensory or physical impairments--; every student in special education must have a statement of transition needs in the IEP. Every student will have some needs, even if the student is in the regular classroom most of the time and receiving very few special education services.

It is not acceptable for the IEP Team to leave the transition page blank, or to make a statement that the 14 year-old student does not need transition services "at this time." The point of the transition statement is to look ahead to where the student is going and determine what skills need to be learned over the next four or five years before graduation. Here are some examples of appropriate transition statements:

John plans to attend a junior college after high school graduation. To prepare himself for doing college level work, John will need to learn word processing with spell check. He will also have to become proficient in using a screen reader in order to read text in content areas. In addition, John needs some practice with such life skills as budgeting, personal organization, and time management.

Molly will need lifelong support in order to be able to live and work in the community. Over the next four years, she will benefit from learning daily living skills such as cooking, grocery shopping, clothes washing, and cleaning. She also needs opportunities to try out various jobs in order to build a work history and acquire some marketable skills.

Informal Planning Process

One way of helping to develop effective transition statements is for the IEP Team to hold an informal futures planning session. Futures planning allows the IEP Team to think broadly about the student's strengths and needs. The team can brainstorm strategies to prepare the student for academic, vocational, and daily living activities after high school graduation.

Futures planning is more than just a plan; it is an ongoing problem-solving process involving a small group of people who meet to brainstorm and strategize. This circle of support or person-centered team makes commitments and takes action to ensure that the student will receive the educational opportunities and experiences that will lead to successful transtion.

If you would like to have one of these informal planning processes for your child, what would you need?

• Facilitators. Usually two are needed, one to interview the group and another to record responses.
• Comfortable Setting. Futures planning meetings are usually held in a home or school setting. Wherever they are held, a relaxed, low key atmosphere should be established.
• Focus Person. The focus person is the individual with a disability for whom the planning session is being held.
• Participants. The key people in the focus person's life should attend the planning meeting. Key people usually include a mixture of close friends, family members, neighbors, church friends, teachers, therapists or doctors.
• Time. A good futures planning meeting takes at least two hours.
• Newsprint and Markers. The recorder uses a process called "group graphics" to organize and portray the information from the group. This process helps the information "come alive" for the group. The facilitator conducting the meeting interviews the group and then the recorder records on newsprint all of the comments made by the group, using colored markers, symbols and words. The recordings produce a series of pictures and symbols that are called "maps" and illustrate the patterns of a person's life. This graphic description becomes the foundation for the futures planning. Using graphic symbols in this way helps to stimulate creativity and to encourage participation by people who have difficulty with words.

Parts of the Planning Process

There are three steps in the Personal Futures Planning process. The first is the creation of a personal profile representing comprehensive information about the individual, including past events, relationships, places, preferences, ideas about the future, obstacles and opportunities.

The second step is the development of a plan for the person based on the information gathered from the group.

The final step is the commitment by the group to form a network of support to help the person carry out the plan.

Strengths and Weaknesses of Futures Planning

Personal Futures Planning is an activity designed to discover new strategies for building a satisfying qualify of life for people with disabilities in their communities. However, the futures planning process is not perfect. It has some potential pitfalls that parents should know about:

• Profile information may focus exclusively on possibilities and ignore real limits and constraints.
• Expectations may be raised too high. They may either be unrealistic, or there may be no path for reaching certain goals.
• Long-range thinking may completely overshadow short-term methods and strategies. Participants may not develop immediate strategies for action. They may ignore real day-to-day issues that require immediate attention and support.
• The process can be irrelevant if the participants in the planning session do not have strong, personal relationships with the focus person.
• The process is dependent on an external facilitator. Experienced facilitators are critical to an effective and creative planning meeting. The facilitator's own skills and values can greatly influence the outcome of the planning process.

To be of practical value the Futures Planning Process has to be coupled with concrete planning processes like the IEP. The dreams recorded in a futures plan can become a reality only if avenues to reaching goals are identified and individuals are committed to helping the focus person reach those goals.

Agreement Reached on Federal Budget

President Clinton and members of Congress reached agreement in November on a budget that gives special education a $500 million increase, and gives local school districts $1.1 billion to help reduce class size and train, test, recruit and hire new teachers.

Clinton won a major victory by securing funds for his plan to hire 100,000 new teachers. While Republicans got Democrats to agree to give the $1.1 billion allocated to support the new teacher program directly to local school districts. Democrats had sought assurances that all of the money would be spent on hiring teachers, but the agreement gives local districts the authority to spend the money as they wish. The GOP plan allows funds to be used not only for reducing class size, but also puts an emphasis on special education by encouraging the recruiting, hiring, training and testing of special education teachers.

As part of the omnibus budget bill debate, vigorous attempts were made by some members of Congress to modify the IDEA discipline provision, but these efforts were turned back. Instead, Congress agreed to a six to eight month study of the discipline of special education students.

School Administrators Lobbied to Amend IDEA Discipline Provisions

During the debate on the budget bill, school administrators lobbied lawmakers to make their job easier by altering the IDEA statue to allow districts to subject all students, including those with disabilities, to the same disciplinary procedures.

The American Association of School Administrators (AASA) urged members of Congress to eliminate the current law's "dual code" of dealing with disruptive behavior in the classroom and replace it with one that "creates the presumption that all students are subject to the same disciplinary code."

According to the AASA proposal, rather than automatically subjecting students with disabilities to a separate standard, all students would fall under one traditional standard. Exemptions from the standard would be determined on a case-by-case basis, subject to an evaluation process.

Under AASA's proposal, exemptions would apply only to students who commit infractions but do not know right from wrong, cannot understand the consequences of their actions, or are incapable of controlling their behavior.

AASA's plan would have applied IDEA's disciplinary rules to disruptive students who meet the exemption criteria. It would have maintained due process requirements and other protections afforded to special education students who are unable to understand the consequences of their behavior.

The AASA proposal would have eliminated manifestation determinations for disabled students for whom the regular disciplinary procedures and code apply.

It would also have maintained the current prohibition against total cessation of services by requiring states to develop alternative settings for student who commit infractions that merit expulsion or long-term suspension.

The AASA proposal received a sympathetic hearing from such members of Congress as Sen. Slade Gorton, R-WA and Sen. Judd Gregg, R-NH. But Congress did not approve the proposal and no amendments were made to IDEA before Congress adjourned.

However, Sen. Gorton is expected to push for some version of an IDEA discipline measure as an amendment to the fiscal year 1999 education spending bill. It is possible that Sen. Gorton will propose the AASA recommendations again in the next Congress.

IDEA Regs Expected Before End of Year

Judith Heumann, the Director of the Office of Special Education and Rehabilitative Services (OSERS) in the U.S. Department of Education, has indicated that she expects regulations to clarify implementation of IDEA '97 will be available before the end of 1998.

Asked about the widespread rumor that the Department of Education delayed the controversial regulations until after the elections, Heumann has indicated that the rumors are untrue. According to Heumann, what has delayed the regulations is the overwhelming number of comments on the draft regulations; these comments are being carefully considered before the final draft of the regulations is published.

Originally the IDEA '97 regulations were supposed to be available in April 1998, then May and finally June. When the regulations did not appear in June, the Department of Education refused to predict a date for publishing the regulations because the process of reviewing thousands of comments was more daunting than first expected.

In the meantime since regulations have not been published, some states have delayed all efforts to update their state regulations until the federal ones are finalized, while others have decided to update part of their regulations. In Montana, Special Education Director Bob Runkel has said that some regulations are in the process of revision because these areas are not likely to be affected by the federal regulations. Other parts of the regulations are being left unchanged until federal guidance is provided.

New Speaker for the House

Just after the November elections, Speaker of the House, Newt Gingrich resigned as Speaker and left his position as a Representative from Georgia. Representative Robert Livingston (R-LA) has been selected to fill the Speaker's post. Congressman Livingston is known to disability advocates as the author of a discipline amendment to IDEA which would have allowed cessation of services.

Supreme Court Hears SPED Case

The U.S. Supreme Court is hearing oral arguments in a medical services case that could have potentially dramatic consequences for students with serous health problems and their families.

The high court has chosen to consider the Cedar Rapids Community School District v. Garret F., 25 IDELR 439 (8th Cir. 1997).

In the case, the 8th Circuit ruled that all services that can be provided in school by a nurse or qualified layperson must be provided to an eligible special education student.

The court said it was bound by the bright-line physician-nonphysician rule in the Tatro case: The services of a physician (other than for diagnostic and evaluation purposes) are subject to the medical services exclusion of the IDEA, but services that can be provided in the school setting by a nurse or qualified layperson are not.

Other courts have not limited their interpretation to a simple "bright-line" rule. Instead, they have weighed several factors in determining whether health care services are required related services or excludable medical services. Those factors include the level of expertise necessary to administer services, whether the student's condition is life-threatening, and the physical and financial burdens of providing services.

A decision by the Supreme Court in this case should make clear the rights and obligations under the IDEA regarding nursing services. The high court will have the opportunity to clarify the scope of the IDEA medical services exclusion and school health services regulation which it first reviewed in Tatro.

Congress Sunsets Assistive Technology Grant Program

The Congress has approved an assistive technology bill that eliminates all funding for the program in fiscal year 2004.

The Assistive Technology Act (S. 2432) reauthorizes the 10-year Tech Act for five years, but will begin phasing out funding for state projects in 2002 with all funding ceasing in 2004. The bill authorizes $36 million in grants to states to provide individuals with disabilities, including students, services or devices that allow them to overcome or compensate for a disability that prevents or limits their ability to engage in a major life activity.

Following their 10-year funding cycles, states were expected to be permitted to roll over into a second grant program called the Challenge Grant Program. However, Congress has repealed that program, thereby officially terminating state grant programs once all states have completed their 10-year cycle. States currently in the 10th and final year of funding will be permitted to extend their grant for 3 additional years, but no extensions will be made beyond FY 2004.

Congress appropriated $36 million to the program last year, but lawmakers have allocated only $30 million for FY 1999, matching the Clinton administration's budget request.

In Montana, MonTECH, located in the Rural Institute on Disabilities in Missoula, has been the Tech Act funded program intended to provide information and assistive technology services statewide.

Good News about Medicaid Coverage for Assistive Technology

Strong advocacy and Administration support have paved the way for important improvements to access for assistive technology for Medicaid recipients. In an official letter on September 4, 1998, to all state Medicaid directors, the federal government has made clear that Medicaid cannot refuse to fund Medical Equipment based on lists of "approved" items. In other words, a determination about whether an item of Durable Medial Equipment is "medically necessary" must be made with reference to the facts of the particular case.

This letter confirms the interpretation of the Medicaid program that advocates have been asserting for many years: The Medicaid program should be covering and providing a wide range of medical equipment and assistive devices to people with disabilities. States cannot raise the defenses that: 1) these devices do not fit with the scope or intent of the Medicaid program; 2) as a state policy, these devices are not deemed medically necessary; or 3) coverage will not be extended to adults, even though the same equipment is covered and provided to children.

For more information on this topic, contact:

Lew Golinker

202 E State St Ste 507

Ithaca NY 14850

607.277.7286; 607.277.5239 (fax)

lgolinker@aol.com

atlawcenter@juno.com

Head Start Reauthorized

On Tuesday, October 27, President Clinton signed into law legislation that reauthorized Head Start for five years through 2003. This reauthorization represents revolutionary change in the purpose of Head Start. With this reauthorization, the purpose of Head Start changes from developing social competence to promoting school readiness by enhancing the social and cognitive development of low-income children through the provision of health, educational, nutritional, social , and other services that are determined to be necessary.

Since its inception in the 1960's, Head Start has emphasized developing social skills in children so that they are better able to cope with the demands of school routines when they enter the public schools. In the past, Head Start has not emphasized teaching children specific academic readiness skills such as letter and number recognition, letter sounds, and language development. The reauthorization requires that Head Start programs focus directly on improving the language and literacy skills of Head Start children. Specifically, the reauthorization establishes educational performance standards to ensure that children participating in the program, at a minimum--

• develop phonemic, print, and numeracy awareness;
• understand and use oral language to communicate for different purposes;
• understand and use increasingly complex and varied vocabulary;
• develop and demonstrate an appreciation of books; and
• in the case of non-English background children, progress toward acquisition of the English language.

In addition, the law establishes educational performance measures to ensure children--

• know that letters of the alphabet are a special category of visual graphics that can be individually named;
• recognize a word as a unit of print;
• identify at least 10 letters of the alphabet;
• associate sounds with written words.

To ensure that classroom teachers in Head Start have the background to provide a more academically-oriented program, the law requires by 2003 that at least 50 percent of classroom teachers nationwide in center-based programs have an associate degree in early childhood education or in a field related to early childhood development with experience teaching preschool children.

The reauthorization legislation strengthens Head Start by promoting school readiness and accountability. The performance of local grant recipients in preparing young children to enter school ready to read will be evaluated using new performance standards and measures. The bill also calls for an impact study to measure Head Start's effectiveness.

Montana's Budget Proposed

As of November 2, 1998, Governor Racicot's budget request to he 1999 Legislature will include an increase for K-12 BASE aid of $30.7 million, increasing the basic and per student entitlements by 3.5% per year for elementary districts and 1.5% per year for high schools, and increasing special education by 1.5% per year. The Governor's request will also include an increase of $1 million over the biennium for Improving Montana Schools, a continuation of the standards review project and the Montana Education Profile.

Resolving Conflict: Early Assistance Program

The legal Services and Special Education Divisions of the Office of Public Instruction (OPI) have instituted the Early Assistance Program (EAP). The EAP is designed to provide technical assistance to parents, school districts and advocacy organizations in regard to the delivery of a free appropriate public education (FAPE) for students with disabilities. Under the Individuals with Disabilities Education Act (IDEA), parents can pursue due process if they feel their student has been denied FAPE, or file a complaint with the Office if they feel a district is not following administrative rules The intent of the EAP program is to intervene prior to the due process hearing stage or at the time of filing a complaint with he Office. At this intervention point, the EAP will gather information pertinent to the situation from parents, schools and others who are involved with the issue and attempt to resolve the problem within fifteen school days. With permission from the parents, EAP may exceed fifteen days.

The philosophy of EAP is to prevent costly legal proceedings wherever possible as well as resolve issues amicably. Given the opportunity to discuss the issues at hand in a less formidable venue, both parents and school personnel can reach agreement without undermining the relationships necessary to ensure the smooth delivery of special education services to children and youth with disabilities. To contact EAP, call Tim Harris at 406.444.5664 or via e-mail at tharris@state.mt.us.

The Legislature is Coming!

The Montana State Legislature will convene in January 1999. For individuals who like to follow the legislative process, there will be a new tool on the Internet.

The LAWS system: http://laws.leg.state.mt.us/law/plsql/LAW0200W$.Startup is a new electronic system containing detailed information on all bills and bill drafts prior to and during the Montana legislative session. The term "LAWS" is an abbreviation of Legislative Automated Workflow System.

A key function of the system is the collection and timely distribution of information related to the Montana Legislature. During a legislative session, floor agendas, journals, and floor action summaries for both of the house chambers will be available from LAWS. The public access portion of LAWS consists of an internet web server that serves information from the legislative session database. The web site also has links to bill text and other elated information.

System Requirements

Use of the public access portion of LAWS requires a computer with an internet connection and a world--wide-web browser. Most public libraries have these. Further to use all of the features of LAWS, browser software must support JavaScript 1.1. Most newer browsers support this. To upgrade browser software, download one at no cost.

LAWS has been tested with Netscape version 3.x and higher, and Internet Explorer version 4.x and higher. Other browsers or versions may or may not work with LAWS. In most cases other browsers will work to get basic information, but some advanced LAWS functions may not work properly or may result in error messages.

The bill data (status and bill text) on LAWS should be up to the minute. As soon as information is recorded on the system, it will be available to users through the LAWS world-wide-web interface. Floor agendas, daily floor action summaries, and journals will be updated once a day in the evening (during the session only).

For a list of all bills and bill drafts go to the Advanced Bill Search page of LAWS and click on the search "Submit" button without selecting any search category criteria.

In addition to LAWS, information about bills and the session will be available in the standard ways. METNET will have the same information as the web page and will be updated as frequently. Hardcopy documents will still be available from the Legislative Services Division.

Montana To Receive $5.6 Million

Under the federal budget just passed by Congress, Montana will receive $5.6 million to be used for hiring approximately 145 new teachers. The one-year appropriation begins July 1, 1999, and extends through September 30, 2000.

OPI must distribute 100% of the funds directly to local school districts, allocating 80% based on poverty level and 20% based on population. School districts must use the funds to reduce class size by recruiting, hiring, and training certified regular and special education teachers. Particular consideration must be given to reducing class size in the early elementary grades. Districts that have already reduced class size in grades 1-3 to 18 or fewer students may use the funds to add special education teachers, further reduce class size in grades 1-8, reduce class size in kindergarten or other grades, or carry out professional development activities.

Services for Deaf Blind Children

Special supports are available for children who are deaf and blind and their families through the Deaf-Blind Partnerships Project which provides education and support in a variety of ways. Support strategies include:

• State lending libraries related to children with dual sensory impairments are available in three locations across the state including the Office of Public Instruction (Helena), the Rural Institute on Disabilities (Missoula), and Parents, Let's Unite for Kids (Billings).
• Onsite technical assistance specific to an individual child's interests and needs is provided for staff members in schools and child care programs, bringing training and resources directly to team members.
• Training institutes are offered at various locations across the state and are available for any individual interested in obtaining general information about children with deaf-blindness.
• On-site assistance for individual children is available upon request by parents, or educators.

Project resources are available for children or young adults up to age 21, their families, and support staff in child care programs and public schools. For more information, contact Francisco Roman at 406.444.4426; TDD 406.444.1812.

Managed Care Continues

The Montana Department of Public Health and Human Services (DPHHS) has been able to negotiate an agreement with Magellan Corporation, the company managing mental health services for the State. Prior to the agreement, both parties had filed termination notices in preparation for severing the contract between Magellan and the State of Montana.

Program Changes

Now that agreement has been reached, DPHHS and Magellan will pursue the following six program changes designed to keep the program intact and viable:

1. Beginning immediately, Magellan/Montana Community Partners will require providers to bill services separately for covered and non-covered diagnoses provided to non-Medicaid members during the same episode of care and will deny payment for non-covered diagnoses. This item does not require a contract change or a rule change.
2. Diagnoses in the categories of "alcoholic psychoses" and "drug psychoses" will no longer be covered by the Mental Health Access Plan (MHAP). These diagnostic categories will be eliminated for non-Medicaid members upon final adoption of administrative rule and contract amendments. They will be eliminated for Medicaid members effective April 1, 1999. For Medicaid recipients, coverage for these diagnoses will be available under the standard Medicaid program.
3. MCP will not be required to reimburse hospitals for emergency room services provided to individuals who do not apply for or are found to be ineligible for membership in the program. Magellan/MCP will still be required to pay other providers for crisis services to non-members and will still be required to pay hospitals for medically necessary emergency services for individuals who are ultimately found to be eligible. This change will become effective upon final adoption of administrative rule and contract amendments.
4. The structure for cost sharing by non-Medicaid members has been changed. Co-payments for most services have been eliminated. The only co-pay will be a $10 prescription co-pay on medications. This will be collected by the pharmacy and is subject to a $50 per month maximum for individual members. In addition, most non-Medicaid members will be charged a monthly premium in order to be members of MHAP. The premiums range from $10 to $50 per month depending on income. There will be no premium for the members in the lowest income range. Because the pharmacy co-pay is already allowed by contract and administrative rule, it will be implemented following notice to consumers. The premium will be instituted upon final adoption of administrative rule and contract amendments.
5. DPHHS will assume responsibility for determining financial eligibility for non-Medicaid MHAP members. This change will take place as soon as the necessary procedures can be put into place following final adoption of administrative rule and contract amendments.
6. DPHHS has announced the availability of up to $1 million in one-time grants to providers to assist in starting up new services needed to offer a more complete array of service and increase the ability of Magellan/MCP to place members appropriately in community-based alternatives to inpatient and residential care. DPHHS is developing the specific guidelines for these grants. This item does not require administrative rule or contract changes.

Managed Care Has Rocky History

In June 1998, DPHHS and Magellan negotiated contract amendments that placed additional operational requirements on Magellan and substantially increased the company's accountability to the State. Then, a July financial audit showed that the contractor had sustained significant financial losses during first-year operations. Magellan requested program changes to help make the contract financially viable, and the six proposals mentioned above were agreed upon. Magellan is also negotiating independently with its service providers.

The Montana managed mental health care program, which began in April 1997, combines all federal and state mental health funding into one privately operated, statewide program. State lawmakers agreed to the plan as a way to provide better mental health services to more Montanans while increasing financial and program accountability.

Magellan Behavioral Health is the nation's largest managed behavioral health care company, serving approximately 61 million individuals across the U.S. and Canada. Magellan took over the management of Montana's program when Magellan bought out Merit Corporation.

Handling the Holidays Happily

Parents often anticipate the holidays with mixed feelings--delight in looking forward to the family's celebration and anxiety about meeting the demands for food preparation, decorations, gift giving, and entertaining. Families that include children with special needs have additional concerns about getting through the holiday rush while maintaining the routine for their special child. Here are some suggestions for holiday survival:

• Keep It Simple. The "picture perfect" Christmases, complete with elaborate home decorations and homemade presents for everyone on the giving list, are just not likely to occur in a home with a special needs child. For parents and children to have fun and enjoy each other at Christmas, expectations must be realistic. If parents are busy with daily therapies for the child, plus the care of other children as well, holiday activities will have to fit into that necessary family routine. If everyone agrees in advance (relatives included) that Christmas is not going to be "perfect," but it is going to be fun, then family members are less likely to be disappointed with the holiday.
• Focus on What Makes You Happy. As the holiday season begins, gather the family together and make a list of the things that make them happy at Christmas. From this list agree on those things that the family can manage this year. Set up a calendar of family events and divide up responsibilities, especially if there are children who are old enough to help. Try to include everyone in the planning and in some of the preparations.
• Keep to Routines. Many special-needs children do not adjust well to changes in routine. During the holiday season it is particularly important for everyone's sanity to stick to those routines that help the family function. Simplify meals and try to have them on time. If you are traveling to relatives during the holidays, try to set up your usual routines in the new environment. Explain to relatives why your family routines are so important. Be sensible about scheduling doctor appointments and diagnostic clinics during the holiday season. Postpone these types of activities until after the holidays if at all possible.
• Guard Against Over-Stimulation. A child with special needs is often more subject than other children to being over-stimulated or easily over-tired. During the holidays, be wise about scheduling rest periods and about allowing the child some quiet recovery time.
• Get Some Respite. More than any other time of the year, parents need respite time for themselves. Arrange now for a baby-sitter so that you can do holiday shopping without children along. Plan for a break well in advance so that you can look forward to it when things get hectic.
• Count Your Blessings. The holiday season is a good time to take stock and think of the good things that having a child with special needs has done for your family. Sure, there have been--and still are--stresses, but there are also enriching experiences, too.

Parent Support Volunteer Network

PLUK has joined forces with Volunteer Montana!, a state-wide service organization, to set up a Parent Support Volunteer Network to expand their support and reach more parents in need. The Volunteer Montana! Volunteer Coordinator, Elizabeth Popp, will be recruiting experienced parents of children with disabilities to provide information and support to other parents. Parent Support Volunteers will receive training from PLUK staff in how to work with parents and share the ways in which they have learned to cope and advocate for their child in the service system.

Parent Support Contacts will give 1 to 2 hours per week of support via the telephone to aid other parents in brainstorming and problem solving techniques, share a variety of information on disabilities, and actively listen to and refer parents to the appropriate people when situations need specific attention. If able, parents may also decide to provide support to parents at IEPs and other school meetings.

If you are interested in becoming a Parent Support Contact or would like more information about the Parent Support Network, please contact Elizabeth Popp at the PLUK office in Billings at 406.255.0540 or 800.222.7585(toll free).

Draft Policy on Aversive Treatment Available

The blue ribbon panel on aversive treatment has concluded its work and produced a much simplified document that outlines when, if ever, aversive treatment may be used with students in special education. The draft policy states:

1. Aversive treatment procedures may be appropriate for an individual student who exhibits behaviors which pose a risk of physical harm to the student or others, or a risk of significant damage to property, or significantly disruptive or dangerous behaviors which cannot be modified solely through the use of positive behavior interventions. Aversive treatment procedures must be designed to address the behavioral needs of an individual student, be approved by the IEP team, and may not be used as punishment, for the convenience of staff, or as a substitute for positive behavior interventions.
2. Aversive treatment procedures are defined as--
   1. aversive mists, noxious odors, and unpleasant tastes applied by spray or other means to cause an aversive physical sensation;
   2. mechanical restraint that physically restricts a student's movement through the use upon the student of any mechanical or restrictive device;
   3. physical restraint, other than as provided in 20-40302, MCA, when the IEP team has determined that the frequency, intensity or duration of the restraint warrants an aversive treatment procedure; and
   4. isolation time-out which results in the removal of a student to an isolation room under the following conditions--
      1. the student is alone in the isolation room during the period of isolation;
      2. the student is prevented from exiting the isolation room during the period of isolation;
      3. the door to the isolation room remains closed during the period of isolation; and
      4. the student is prohibited from participating in activities occurring outside the isolation room and from interacting with other students during the period of isolation.
3. A student in isolation time-out must be under the direct constant visual observation of a designated staff person throughout the entire period of isolation.
4. The following procedures are prohibited:
   1. any procedure solely intended to cause physical pain,
   2. isolation in a locked room, and
   3. the withholding of a meal for a period of greater than one hour from its scheduled starting time.
5. Exclusion time-out is not considered an aversive treatment procedure. Exclusion time-out is defined as any removal of a student from a regularly scheduled activity for disciplinary purposes that does not result in placing the student in an isolation room under all of the conditions described in Subpart 2d.
6. IEPs shall include the use of aversive treatment procedures only when:
   1. subsequent to a functional behavioral assessment, a series of not less than two positive behavioral intervention strategies were previously implemented, which were designed to target the behavior to be changed;
   2. the IEP team includes a person knowledgeable about best practices in the application of aversive treatment procedures and positive behavior interventions; and
   3. a written behavior intervention plan using aversive treatment procedures is developed and incorporated as part of the IEP.
7. A behavior intervention plan using aversive treatment procedures shall:
   1. include a statement describing no less than two positive behavioral intervention strategies previously attempted and the results of these interventions, as described in Subpart 6a;
   2. describe the target behavior(s) that will be consequented with the use of the aversive treatment procedure(s);
   3. include short-term objective(s) with measurable criteria stating the expected change in the target behavior(s);
   4. provide a written description of the aversive treatment procedure(s);
   5. specify a time limit for the use of the aversive treatment procedure for any one instance;
   6. include data collection procedures for recording each application of the aversive treatment(s);
   7. state when the IEP team will meet to review the ongoing use, modification or termination of the aversive procedure;
   8. designate an individual responsible for ongoing review and analysis of the data on the target behavior;
   9. state how the student's parents will be regularly informed of the progress toward the short-term objectives in the IEP at a frequency no less than is required in CFR 30.347; and
   10. state whether any standard school disciplinary measures are waived.
8. When an aversive treatment plan is incorporated in the IEP, the parents must be informed that their consent to the IEP includes consent for the aversive treatment plan. Failure to obtain consent is subject to due process proceedings under ARM 10.16.2401-10.16.2417.

Aversive Treatment to Be Last Resort

Under the proposed policy, it is assumed that aversive treatment will be considered for use only rarely. The policy requires that two positive behavioral interventions must be tried and documented before an IEP Team can even consider using aversive treatment. If aversive treatment is under consideration, the IEP Team must include someone with experience in positive behavior management and in best practices in the use of aversives.

As a member of the IEP Team, a parent will have the ability to agree or disagree with an IEP that contains aversive treatment. If the parent does not want to agree to aversive treatment, the school district would have to take the parent to mediation or due process hearing to press for the use of aversives.

If a parent agrees to an IEP with an aversive treatment plan in it, the parent can expect to receive regular updates on how the plan is working. There must be an indication of when the first formal review will occur. If parents are not satisfied with the data they receive, or if the parents feel that the aversive treatment plan is not effective, the parents can call for an IEP Team meeting to revise the IEP.

If a parent thinks that aversive treatment is being proposed as a form of punishment, a convenience for staff or a substitute for a positive behavioral intervention, the parent can refuse to agree to the IEP as written. The parent could then request mediation or a due process hearing. In the meantime, while due process procedures are taking place, the school district could not implement aversive treatment procedures without the parent's consent.

Comments on the draft policy may be sent to:

Office of Public Instruction

PO Box 202501

Helena MT 59620-2501.

Doug Doty of the OPI staff can answer questions about the draft document. He can be reached at 406.444.0907.

Members of the Blue Ribbon Panel on Aversive Treatment include:

Kathy Kelker, PLUK; Craig Brewington, Superintendent, Hellgate Elementary, Missoula; Denise Conrad, Elementary Principal, Great Falls Elementary, Great Falls; Ed Plass, High School Principal, CM Russell High School, Great Falls; Mike Fredrickson, Special Education Director, Missoula County High School, Missoula; Leigh Spencer, Parent, Great Falls; Brenda Price, General Education Teacher, CR Anderson School, Helena; Mike McLaughlin, Director of Adult and Family Services, Golden Triangle Community Health Center, Great Falls; Pete Ruzevich, Montana Advocacy Program, Helena; Joelene Goodover, School Psychologist, Great Falls; Ron Marks, Special Educator, Hawthorne School, Missoula; Carol Reeves, Special Educator, Lewis and Clark School, Missoula; and Brian Garrity, Consumer Advocate, Mental Health Association of Montana, Helena.

CEC Conference to be held in March

The CEC conference is scheduled for March 24-26, 1999 at the Holiday Inn-Parkside in Missoula. Lodging at the Holiday Inn Parkside (800.399.0408) is $56.00 for 1-4 persons; or the Best Western Executive Inn (406.543.7221) is $42.00 for a single or $52.00 for a double.

Call Continuing Education at the University of Montana at 406.243.4600 for more information.

Items For Sale

1995 Chevy Astro Van

-conversion lift

-raised roof(enough room for adult)

Call 1-800-CAR-CHEV, ask for Jason Nordberg.

New electric Wheelchair -- Call-406.522.7120

ASK PLUK???

The following questions are recent inquiries received by PLUK staff.

Q: Is an IEP meeting required before a student with disabilities graduates from high school?

A: High school graduation is considered a change in placement for a student with a disability in that eligibility for special education and related services ceases upon granting a diploma. Since graduation ceases a student's access to special education programs, all of the procedural safeguards required under IDEA are in effect, including written notice and due process hearing procedures, and must be given at the IEP meeting that evaluates whether the student has met graduation requirements.

As the student is nearing graduation, an IEP meeting must be held to conduct a review of the student's IEP to evaluate the student's progress toward graduation. The IEP team determines whether graduation requirements will be met and whether the goals and objectives in the IEP will be completed.

The student is eligible for graduation from high school if the student has completed a prescribed course of study. A prescribed course of study can be the general education curriculum or completion of the goals on the IEP, or some combination of the two.

If a student's IEP has identified graduation on a specified date and the IEP team decides that the student has not met graduation requirements, written prior notice that the student will not meet graduation requirements must be given to the parents and student early enough so that parents may exercise their procedural safeguards including requesting a due process hearing. If the student or parents of the student request a due process hearing, the impartial hearing officer would determine whether it is appropriate to graduate the student.

Q: Does the Americans with Disabilities Act (ADA) apply to child care centers?

A: Yes. Privately-run child care centers--like other public accommodations such as private schools, recreation centers, restaurants, hotels, movie theaters, and banks--must comply with title III of the ADA, regardless of size or number of employees. Even small, home-based centers that may not have to follow some State laws are covered by title III.

The exception is child care centers that are actually run by religious entities such as churches, mosques, or synagogues. Activities controlled by religious organizations are not covered by title III.

Title III of ADA requires that child care providers not discriminate against persons with disabilities on the basis of disability, that is, that they provide children and parents with disabilities with an equal opportunity to participate in the child care center's programs and services. Specifically:

• Centers cannot exclude children with disabilities from their programs unless their presence would pose a direct threat to the health or safety of others or require a fundamental alteration of the program.
• Centers have to make reasonable modifications to their policies and practices to integrate children, parents, and guardians with disabilities into their programs unless doing so would constitute a fundamental alternation.
• Centers must provide appropriate auxiliary aids and services needed for effective communication with children or adults with disabilities, when doing so would not constitute an undue burden.
• Centers must generally make their facilities accessible to persons with disabilities. Existing facilities are subject to the readily achievable standard for a barrier removal, while newly constructed facilities and any altered portions of existing facilities must be fully accessible.

For more information about ADA requirements, call 800.949.4232.

Q: In January our family is moving to a new community. Our son, who is a high school junior, uses a wheelchair. The new school district's only high school is not accessible to individuals who use wheelchairs. The new district proposes to transport our son to an accessible high school in a neighboring district. We are not happy with this idea. We want our son to attend school with his brothers and sisters in our new community. What should we do?

A: Under the Americans with Disabilities Act (ADA), the school district's high school may not be inaccessible to individuals who use wheelchairs. The school district may not meet its program accessibility obligation by sending students with disabilities to an accessible school in a neighboring district. This means that the high school building does not have to be accessible throughout, but any programs in which your son would want to participate must be made physically accessible for him.

Contact the Legal Department of the Office of Public Instruction at 406.444.4402 and ask for assistance in informing your new school district of their obligations to provide accessible programs for your son.

Q: Our son was recently diagnosed with diabetes. He is having a great deal of difficulty adjusting to his illness and has been hospitalized twice in the last month. Because he has been having so many problems, we are concerned about his returning to school. What kinds of accommodations can be made for him in the school setting?

A: Once their diabetic symptoms have been stabilized, most children with diabetes can lead normal lives and participate in school in the same ways as other children. However, diabetic children do require some accommodations to ensure that they remain healthy during the school day. A Section 504 plan can be used to spell out the types of accommodations that may be necessary, including:

• A private place to do blood sugar testing at least once a day. Younger students generally go to the nurse's room. Older, high school students may use a quiet corner in the school office or locker room.
• Physical education scheduling awareness (PE should not be scheduled during a time when your son is likely to have a low insulin level).
• Freedom to go to the bathroom or water fountain when necessary.
• Ability to eat whenever and wherever necessary.
• Full participation in all extracurricular activities, including sports and field trips.
• Allowances for being out sick more than the traditional amount.
• An emergency plan--what to do if the student has a bad reaction. The emergency plan should consist of a physician's order and a permission form on file allowing the school nurse, who may be a registered nurse or a licensed practical nurse, to administer a glucagon injection if the student should become unconscious. If the nurse is not available, an emergency medical technician must administer the shot.

The plan should also include treatment for high blood sugar. Sometimes, when diabetics have a fever, they are under stress or they are coming down with an illness, their blood sugar will rise too high. They will appear drowsy, sluggish and their breath will smell fruity. Clear instructions should be provided on administration of insulin to treat symptoms of high blood sugar.

Emergency procedures also should be detailed in the plan for the student's bus ride to and from school and for field trips. Bus drivers should be informed of the student's diabetic condition.

The Office of Public Instruction (OPI) has forms to use when developing an Individualized Health Care Plan. You can obtain the forms by calling 406.444.4429.

For more information, contact the American Diabetes Association at 800.342.2383 or visit the association website at http://www.diabetes.org.

Q: My daughter is in middle school. She has been served in special education for a learning disability in reading and written language since she was in second grade. Now in the seventh grade, the only help she gets at school is from a strategies class one period a day. My daughter is failing three core subjects and she hates the strategies class. She says it is no help to her. We don't know what to do to help our daughter. Is there something more that could be done besides this strategies class?

A: It sounds as though your daughter may not be receiving enough support for her to be successful at school. What you need to do is ask for an IEP meeting and revise her IEP so that it clearly spells out more supports for her.

The strategies class you mentioned is a common method for providing assistance to learning disabled students. The purpose of this class is to teach LD students how to organize their school work, how to study, and how to take tests. These are all useful skills for students with learning problems; however, some LD students need more support than instruction in study skills. They may actually require instruction in reading in the content areas, written expression, and other tool skills that they have not mastered yet.

When the IEP Team meets, be sure that your daughter's revised IEP includes goals and objectives in areas other than study skills. With these additional goals, she should receive more support, either in collaborative classes where the special and regular education teachers team teach or in resource classes designed to provide instruction in specific skills.

Q: Must school districts provide transportation for a high school student who uses a wheelchair to participate in extracurricular events? My son plays the trumpet and would like to be in pep band. He is being discouraged from participation because the band would have to be transported on a special bus that accommodates wheelchairs. Can we insist that our son be allowed to participate and be provided transportation?

A: Under the Americans with Disabilities Act (ADA), you son is entitled to participate in any of the school-sponsored activities for which he is qualified. Since your son plays an instrument, he is certainly entitled to try out for the pep band. If he is successful in becoming a member of the band, then he should be afforded any of the opportunities that other band members enjoy, including transportation to sporting events on an accessible bus.

If you need help with this issue, call the ADA Technical Assistance Center at 800.949.4232 or OPI Legal at 406.444.4402.

Parent Corner

Items of interest to parents

Arresting Material

The following publications may be of interest to people concerned about how the Americans with Disabilities (ADA) affects law enforcement. To order them, call the Rocky Mountain ADA Technical Assistance Center at 800.949.4232.

--Commonly Asked Question about the ADA and Law Enforcement (free)

--The Police Response to People with Mental Illness ($4.00 postage and handling)

SSI Information

The Bazelon Center for Mental Health Law has recently published a handbook for families and advocates which explains the Supplemental Security Income (SSI) system and the process for qualifying for monthly cash benefits for children with severe mental and physical disabilities. The1996 eligibility rules as well as the process for appealing when benefits are denied are described in easy to understand language. The handbook is also available in Spanish. The cost is $3 plus $2 for shipping. To order this booklet, please contact the Bazelon Center at 202.467.5730 or write:

Publications Desk

Bazelon Center for Mental Health Law

1101 15th Street NW Ste 1212

Washington DC 20005-5995.

Federal Monitoring

The Office of Special Education Programs (OSEP) will monitor Montana's compliance with the Individuals with Disabilities Education Act (IDEA). The schedule calls for a "pre-site" visit the week of March 8-12, 1999. An "on-site" visit, which will include visits to our schools, is scheduled for April 12-16, 1999.

Poster Contest

The Developmental Disabilities Planning and Advisory Council is conducting the Fifth Annual Poster Contest to create the statewide poster for Disabilities Awareness Month in March 1999. This year's contest participants are asked to think about ways that people with and without disabilities are the same and design a poster that helps to illustrate the theme, "More the Same Than Different."

The winners of each category will be brought to Helena in March for an awards presentation. The overall winner will be selected from these finalists. Prizes are being provided by the Montana Association for Independent Disabilities Services (MAIDS) and the Montana Power/Entech Foundation.

Posters must be submitted to the DD/PAC office by December 18, 1998. For further information, call 800.337.9942.

Discipline and IDEA '97

Discipline of students with disabilities remains a priority issue with school administrators, parents, and the Office of Public Instruction (OPI). OPI will revise the draft Technical Assistance Manual on Suspension in Special Education as soon as possible, following adoption of final federal regulations. Once the Manual is finalized, training opportunities will be provided by OPI. In the meantime, the draft Manual published in January 1998 provides guidelines for schools to use in implementing the discipline requirements of IDEA '97. Additional copies of the draft manual are available by calling 406.444.5661.

Curbing Injuries on Ranches

The National Safe Kids Campaign has launched an effort to ensure the safety of ranch children, about 100 of whom are killed each year and about 150,000 of whom are injured. To obtain a copy of the guidelines for keeping ranch children safe, call 202.662.0600.

Online Cancer Resources

Life Care Concepts, an organization of cancer survivors and care givers, has a new Web site that targets cancer patients and their families. The site provides disease management and psychosocial information and can be reached at http://www.cancerresources.com.

Avoiding Food Allergies

For tips and strategies on how to avoid food allergy, including information about the School Food Allergy Program or how to get a free emergency health care form, call the Food Allergy Network at 800.929.4040 or visit their Web site at: http://www.foodallergy.org.

Books on Tape

For students who have visual impairments, learning disabilities or other print impairments, the following are good resources for books on tape:

--The Library of Congress, Washington DC; 202.707.5100

--Montana Talking Book Library, Helena; 800.332.3400

--Recording for the Blind, Princeton NJ; 800.221.4792.

Special Ed Advocate

The Special Ed Advocate is a free online newsletter about special education legal issues, cases, tactics and strategy, effective educational methods, and Internet links. Visit: http://www.wrightslaw.com.

Dr. Koop's Community on the Web

Dr. Koop's Community is an extensive website maintained by the Empower Health Corporation, a company founded by former Surgeon General C. Everett Koop and dedicated to improving the quality of people's lives by empowering them with personalized health care information and enabling electronic interactions with the health care industry. Dr. Koop's Community is on the Web at http://www.drkoop.com.

Learning Differences Web Site

The Hello Friend/Ennis William Cosby Foundation was established by Bill and Camille Cosby to honor the memory of their son, Ennis, and dedicated to the issue of learning differences. Go to: http://www.hellofriend.org.

LD Pride Online

LD Pride is an online community of adults and youth. The purpose of this website is to provide individuals with learning disabilities a way to interact with each other, socialize, share frustrations, and get the support they need. Users can sign or read the guest book, post a message on LD Pride's Bulletin Board, test knowledge of learning disabilities by taking the LD Pride's Quiz Challenge, or join the live JAVA Chat Support Group. Visit: http://www.ldpride.net.

ADA Information

For information about the Americans with Disabilities Act (ADA), call the Rocky Mountain Disability and Business Technical Assistance Center at 800.949.4232. The Technical Assistance Center stocks a large selection of current information on the ADA. These materials can be ordered by calling the Center. Most are free except for a small fee to cover postage.

The TA Center staffs the toll free number weekdays from 8:00 a.m. through 5:00 p.m. The Center's Information Specialists can immediately answer most questions you have about the ADA and can research more complex questions if necessary.

Accessible Congregations

The National Organization on Disability (NOD) is seeking the commitment of 2,000 religious congregations by the year 2000 to include people with all types of disabilities as full and active participants.

An Accessible Congregation acknowledges that it has barriers to the full participation of people with disabilities and makes a commitment to begin removing them. An accessible Congregation commits to these three principles:

• In our congregation, people with disabilities are valued as individuals, having been created in the image of God.
• Our congregation is endeavoring to remove barriers of architecture, communications and attitudes that exclude people with disabilities from full and active participation.
• People, with and without disabilities, are encouraged in our congregation to practice their faith and use their gifts in worship, service, study and leadership.

For more information, contact Lorraine Thal at 202.293.5960 or 202.293.7999 (fax).

Montana Center Awarded New FAS/FAE Projects

The Montana Center on Disabilities is beginning two new alcohol related birth defect projects. Funds from the Developmental Disabilities Planning and Advisory Council (DDPAC) and Board of Crime Control will be used to increase statewide public awareness and agency coordination of services for children and adults with FAS/FAE and will provide training to juvenile probation officers across the state. Parents are welcome to attend all grant activities. For more information, please contact Linda Wham at 888.866.3822 or 406.657.2312, mchc_dept@vixen.emcmt.edu.

Autism Society Support Group in Billings

The Autism Society of Montana is a support group for parents of children with Autism spectrum disorders. This includes Autism, PDD, and Asperger Syndrome. The group of parents meets to share information, support each other during tough times and share triumphs. All parents and family members are welcome. The group meets at MSU-Billings Education Building Room 104 each quarter. The next meeting will be January 7th at 6:30-8:30pm. For more information, please call Liz Miller at 406.651.9260.

Foundation for Aniridia Research

The Canadian Foundation for Aniridia Research is a non-profit organization dedicated to raising public awareness of Aniridia and its associated conditions. Originally started in Canada, CFAR now has members in over 7 countries and includes a resource contact in the USA, Mrs Liz Dennis, 770.631.9333; 770.631.8332 (fax); LizDenn@aol.com (e-mail). They provide support through a newsletter, information flyers, web site, and on-line chats. Visit their web site at http://www.aniridia.org.

50 Tips for Coping with Mental Illness in the Family

(adapted from a list developed by Rex Dickens for NAMI Sibling and Adult Children Network)

1. Remember you cannot cure a mental disorder for a family member.
2. Despite your efforts, another's symptoms may get worse or may improve.
3. If you feel too much resentment, you are giving too much.
4. It is as hard for the individual with the mental illness to accept the disorder as it is for other family members.
5. Acceptance of the disorder by all concerned may be helpful, but not necessary.
6. A delusion will not go away by reasoning and therefore needs no discussion.
7. You may learn something about yourself as you learn about a family member's mental disorder.
8. Whenever possible, separate the person from the disorder. Love the person, even if you hate the mental disorder.
9. Separate medication side effects from the disorder and the person.
10. It is not okay for you to be neglected. You have needs and wants, too.
11. The mental illness of a family member should not make you feel ashamed. Reality is that you may encounter discrimination from an apprehensive public.
12. No one is to blame for the occurrence of a mental illness.
13. Don't forget your sense of humor.
14. It may be necessary to renegotiate your emotional relationship.
15. It may be necessary to revise your expectations.
16. Success for each individual may be different.
17. Acknowledge the remarkable courage your family member may show dealing with a mental disorder.
18. Your family member is entitled to his or her own life journey, as you are.
19. Survival-oriented response is often to shut down your emotional life. Resist this.
20. Inability to talk about feelings may leave you stuck or frozen.
21. The family relationships may be in disarray in the confusion around the mental disorder.
22. The mental illnesses, like other diseases, are a part of the varied fabric of life.
23. Shed neurotic suffering end embrace real suffering.
24. The mental illnesses are not on a continuum with mental health. Mental illness is a biological brain disease.
25. It is absurd to believe you may correct a physical illness such as diabetes, the schizophrenias, or manic-depression with talk, although addressing social complications may be helpful.
26. Symptoms may change over time while the underlying disorder remains.
27. The disorder may be periodic, with times of improvement and deterioration, independent of your hopes or actions.
28. You should request the diagnosis and its explanation from professionals.
29. Identical diagnoses does not mean identical causes, courses, or symptoms.
30. Strange behavior is a symptom of the disorder. Don't take it personally.
31. You have a right to assure your personal safety.
32. Don't shoulder the whole responsibility for your mentally disordered relative.
33. You are not a paid professional case worker. Work with them about your concerns. Maintain your role as the sibling, child, or parent of the individual. Don't change your role.
34. Mental health professionals, family members, and people with mental illnesses all have ups and downs when dealing with a mental disorder.
35. Forgive yourself and others for mistakes made.
36. Mental health professionals have varied degrees of competence.
37. If you can't care for yourself, you can't care for another.
38. You may eventually forgive your member for having mental illness.
39. The needs of the ill person do not necessarily always come first.
40. It is important to have boundaries and set clear limits.
41. It may be therapeutic to you to help others if you cannot help your family member.
42. Recognizing that a person has limited capabilities should not mean that you expect nothing of them.
43. Mental disorders affect more than the afflicted.
44. Your conflicted relationship may spill over into your relationships with others. You may unconsciously reenact the conflicted relationship.
45. It is natural to experience a cauldron of emotions such as grief, guilt, fear, anger, sadness, hurt, confusion. You, not the ill member, are responsible for your own feelings.
46. Eventually you may see the silver lining in the storm clouds: increased awareness, sensitivity, receptivity; becoming more compassionate and mature; and becoming less judgmental, self-centered.
47. Allow family members to maintain denial of the illness if they need it. Seek out others with whom you can talk.
48. You are not alone. Sharing your thoughts and feelings with others in a support group is helpful and enlightening for many.
49. The mental disorder of a family member is an emotional trauma for you. You may pay a price if you do not receive support and help.
50. Support the search for a cure.

Hints for Making Tough Decisions

Parents of Children with special needs often find themselves faced with making tough decisions about their children's medical, therapeutic, or educational programs. General life experience does not always prepare parents for these difficult decisions, and often there are no family members or friends who have the expertise to help.

Here are some suggestions for steps to follow when contemplating challenging decision:

• Be aware that you cannot control the outcome of a decision. All you can do is control the decision-making process.
• Start the process by identifying your wants and needs. Jot them down on paper--even if they are contradictory.
• Rank the things you want and need. If you spot contradictory needs, ask yourself, "Which would I choose?"
• Gather all the information necessary to make that decision. Look at alternatives, consequences, advantages and disadvantages. Don't let your emotions interfere with this process. Be as objective as possible.
• Determine how much of a risk you are willing to take. Once you have done this, consider these strategies:
  • Choose the safest alternative--the one that cannot fail.
  • Pick the option with the best odds of success.
  • Select the alternative with most desirable outcome--despite the risk.
• Eliminate any option that might present a loss you will not be able to live with--despite high odds for its success.
• Picture how you would deal with negative consequences.

Source: Janet Bailey, writing in New Woman, 215 Lexington Ave., New York NY 10016.

Handling Crises

• Be alert for warning signs. Seldom will a person suddenly lose total control of thoughts, feelings, and behavior. Warning signs include: sleeplessness, ritualistic preoccupation with certain activities, suspiciousness, unpredictable outbursts. During these early stages a full blown crisis can sometimes be averted. If the person has ceased taking medications, encourage a visit to the physician.
• Remain calm. Your task is to help the individual regain control. Do nothing to agitate the person.
• Speak softly and in simple sentences. Don't shout. If the person isn't listening, other "voices" (auditory hallucinations) may be interfering.
• Summon professional help. If indicated, call the police, but instruct them not to brandish weapons.
• If alone, call someone to stay with you until professional help arrives.
• Don't threaten. This may be interpreted as a power play and increase fear or prompt assaultive behavior.
• Don't criticize. Criticism may make matters worse; it can't make things better.
• Don't squabble with other family members over what to do or whom to blame.
• Don't bait the individual into acting out wild threats; the consequences could be tragic.
• Don't stand over the person. If the individual is seated, seat yourself.
• Avoid continuous eye contact or touching.
• Comply with requests that are not endangering or beyond reason. This gives the individual the opportunity to feel somewhat in control.
• Don't block the doorway, but keep yourself between the person and an exit.

For more information on handling mental health crises, contact:

National Alliance for Mentally Ill

200 N Glebe Rd Ste 1015

Arlington VA 22203-3754

703.524.7600; 703.524.9094 (fax)

http://www.nami.org.

Tips for Handling Tough Conversations

Most of us dread confrontations with others. We would prefer that our interactions would be pleasant rather than hostile, but sometimes difficult conversations must take place.

If you want to avoid potential stress for you and those with whom you are dealing, consider these suggestions when you think you are going to be in a stressful conversation:

• Begin with agreement. If you know you are going to be disagreeing with someone, start off your discussion with some area on which you both agree. Even if it requires really digging to uncover that common ground, do it. Example: I know that you have found John's behavior difficult to control at school. We have had similar difficulties at home.
• Say "and"--not "but." "But" acts like an eraser inside people's heads. It erases the value of anything said before it in a sentence. Example: We need a plan to get John's behavior under control AND we must not lose track of how much John needs to experience academic success in the classroom.
• Use lots of "I" statements. Limit "you" statements. "I" clarifies for the other person what you think and feel while "you" can make a person feel criticized. "I" also reduces defensiveness and fosters communications. Example: I am feeling discouraged because the information that I receive about John seems so negative.
• Avoid negatives and absolutes. Use of negative or absolute statements shuts down communication.

  Examples:
  Negative: Why can't you..."
  Positive: "What if we..."

  Negative: I hate it when..."
  Positive: "Wouldn't it be better if..."

  Absolute: "You always say..."
  Non-absolute: "I've heard you say..."

  Absolute: "Nothing ever gets done."
  Non-absolute: "At times, there have been problems getting things done."

  Absolute: "We must do it this way.":
  Non-absolute: "Here's a good idea to consider."

  Whenever you expect that a conversation may be difficult, rehearse in your mind these four suggestions and consciously decide to monitor the way that you speak. You may be surprised at how positive the resulting conversation can be.

Dealing with Difficult People

When you think that the people with whom you will be interacting may be difficult, consider using these strategies:

• "Kill" with kindness. Treat everyone well regardless of how people treat you. Be direct--but likable and polite. It is difficult to treat a thoughtful person thoughtlessly.
  
• Listen and respond. Allow the difficult person to express fully his or her feelings. Then acknowledge your awareness of what the person has said. Reflect back your version of what you have just heard. Tip: Don't judge ("You shouldn't be that way") or generalize ("you always do that"). This gives the person an opportunity to correct any misunderstanding on your part.
  
• Describe your sense of the situation using nonevaluative terms. Simply tell about what you have seen and heard, reveal what you think and feel, and state what you would like to have happen. Example: What I see at home is that John has four to five hours of homework every school night. Often he does several hours of schoolwork on the weekends. He appears to have no time to relax and enjoy other things. When I observe him working so hard and not experiencing success, I feel discouraged and upset on his behalf. I want to modify John's school program so that he has less homework and the homework he does have is profitable for him.
  
• Don't take a position--deal with a need. Find out what motivates a person, so you can offer alternative ways of solving the problem. Chances are the difficult person confronting you has simply adopted the most obvious solution. In other words, move from what the person wants to why the person wants it. Example: I know that you have many students and that it is difficult to individualize homework assignments. Perhaps we could agree on a time limit for work done at home--maybe two hours--, and grade John only on what he has been able to complete.
  
• Be "for" something. In conversations with difficult people, avoid being against anything. Instead be for something that constitutes positive change. For example instead of being against the school district absence policy, be for finding ways to keep children coming to school (e.g., changes in curriculum, incentives for good attendance, examinations to test out of classes).

  Generally speaking, whatever you are against works against you. You begin fighting it and become a part of the problem. But when you state what you are for, you begin focusing on the potential for positive change. Your positive suggestions will impress others more than your criticisms will persuade them.

• Ask questions. Some difficult people are know-it-alls who do not listen to other people's ideas. When dealing with a know-it-all, don't attempt to be a know-it-all in return. When you disagree with know-it-alls, they will immediately freeze their plans and won't budge. Then you've created a standoff.

  Instead of telling the know-it-all why the idea will not work, ask questions about the idea. Remember that know-it-alls love to answer questions.

  As they look for answers, they might just discover that some ideas you present might be useful. In fact, they will probably blend some of your ideas with theirs and think that they came up with all of them.

  Examples:

  --Why do you think suspending John from school will change his behavior? What do you think the effect of suspension will be?

  --Have you had success talking with John when he is angry? How does John respond when you confront him about his behavior?

• Keep communication going. When you get into arguments in which you and the other person have developed rigid viewpoints, your comments are likely to become increasingly bitter until all progress stops. In these cases, the problem is really a breakdown in communication.

  When a communication impasse occurs, try this technique. Stop the discussion. Ask the other person to agree to a new ground rule for both of you--Neither will be allowed to speak up for himself or herself or to state his or her side of the argument until each has stated the other's ideas and attitudes to the other's complete satisfaction.

• Accept blame. When you have consciously or unconsciously offended the other person, admit what your fault is quickly and emphatically. Whenever you shoulder your share of the blame, others are more likely to own up to theirs. Tip: Sometimes you can encourage the other person to cooperate by claiming more responsibility than you deserve. Example: I might have sounded a bit irate when I called about John's homework. I apologize if I came across as demanding. I was just so stressed from trying to help John each night. I guess I needed to vent my frustrations. I'm sorry I took it out on you.

Source: Leatz, C. (1997). Career success/personal stress. New York: McGraw-Hill Inc.

Deep, S. & Sussman, L. (1997). What to say to get what you want. Reading, MA: Addison-Wesley Publishing Co.

Parent Reports on TS Conference

On October 16-18, Audrey Mauritzson and her husband Randy attended the National Tourette Syndrome Association Conference in Washington, D.C. What follows is an excerpt of their report of the conference.

...There were sessions on pharmacology, genetics, parenting, advocacy, and anger management. The information received was both useful and empowering; such as new treatments (still experimental) of injected botulum toxins and transcranial magnetic stimulation to enhance or turn down electric brain circuit activity. The anger management panel stressed the importance of teaching the child to focus on their feelings and what's going on inside, in order to help them understand the effects of their tics on themselves and others. The panel suggested 3 absolutes to be observed by all family members during an anger episode; 1) nobody may hurt another person, 2) nobody may damage another's belongings, and 3) when tempers flare, one person must leave the room until calm. The panel also pointed out the difference between punishment, and the 5 elements of discipline which are; 1) clearly relate expectations, 2) consistency- no negotiating, 3) modeling, 4) a mutual search for effective problem solving, and 5) nurturing a positive relationship where empathy and respect flourish.

We brought back tons of printed handouts on both child and adult advocacy, anger management, classroom issues, information for teachers, neuropsychological tests, related learning problems, and IDEA and 504. We also purchased a cassette on genetics that clearly explains the origins of Tourette Syndrome. All of this information is now available through the PLUK library.

When to Call the Doctor

Parents often are uncertain about when it is necessary to call the doctor, what constitutes an actual emergency, and what can be dealt with easily at home. Here are some suggestions for parents that you may want to discuss with your child's primary care physician:

Emergency Calls (Day or Night)

• Call 911 (emergency medical services) for life-threatening emergencies in which your child may require resuscitation (your child is not breathing, is choking severely, is unconscious, or is having a prolonged seizure, for example).
• Call the doctor's office for minor emergencies such as dehydration, difficulty breathing, wounds that need suturing, or fractures. When you call in, always state clearly, "This is an emergency." Do not let the answering service or office staff put you on hold.
• For poisonings, call the poison control center (usually listed in the phone book under emergency numbers).

Calls About Sick Children during Business Hours

If your child is sick and you want the doctor to see him or her, call ahead for an appointment so you will not have to wait too long. Try to call about sick children during early morning office hours so the appointment can be made for that day.

In most doctor's offices, telephone calls are screened by a nurse who has been specially trained to make a decision about which patients need to be seen by the doctor and how to provide home care for children who do not need to be seen. If the nurse cannot help you, he or she will ask you to bring your child to the office or have your physician call you back.

If your child has an unusual health condition or a disability that affects health, please mention this condition when you call in. Sometimes, the disability or health condition has no relevance and other times it may be important in deciding whether or not the child should be seen.

If the staff answer the telephone and can only take a message, ask for an approximate callback time. While waiting for a callback, try to keep your line open. If your call is not retuned within 60 minutes after the predicted callback time, call again. In general, most calls to physicians can be returned within 15 minutes. Keep in mind, however, that Monday mornings are the busiest time and the most likely time when the waiting period may be longer.

Working Parents with Sick Children

These days most physicians save some appointment times during the last hour of the work day for sick children who need to be seen after school or day care. Make sure your baby-sitter or day-care center understands that they should call you, the parent, before 3:00 pm if your child becomes ill. If you know about the child's illness in time, you can probably make sure that the child is seen that same day.

Well Child Questions

Physicians are generally happy to provide you with the health information you need to be able to handle your child's normal growth and development. Consider placing calls about behavior questions or other well-child issues during regular office hours. The best time to call is usually early afternoon when the office staff is less busy than first thing in the morning.

Nighttime (After-Hours) Calls

After office hours, call the physician only for emergencies or urgent problems that cannot wait until morning. Calls about mild illnesses can usually wait. At night, the telephone lines need to be kept open for urgent calls. Most physicians use an answering service after office hours. The answering service will receive your call and transfer the information to your physician or whoever is covering for the practice. The doctor on call will usually return your call within 15 minutes. If you do not receive a callback within one hour in a nonemergency situation, call again.

Weekend and Holiday Calls

If your child becomes ill or is injured during a holiday, call the answering service. If possible, call before noon so the physician can plan when to see your child. After 5:00 pm, limit calls to emergencies or other urgent problems that cannot wait until morning.

Information for the Physician

When you call the physician have the following information ready:

• Your child's main symptoms
• Any chronic disease or health problem your child has
• Your child's temperature if he or she is sick
• Your child's approximate weight (for calculating drug dosages)
• The names and dosages of any medicines your child is taking
• What you have already done to treat the illness (e.g., given cold medicine, run the vaporizer)
• Your pharmacy's telephone number
• Your questions (it is a good idea to write them down).

Always have a pencil and paper handy to take down instructions. Don't be shy about asking the doctor to spell the names of medications that are recommended. Have your child nearby when you are talking to the doctor in case you need to check something about the child's condition (e.g., is there are rash? are pupils dilated?).

Giving some thought in advance to how you will manage medical problems will help you to establish a better working relationship with your child's physician and will also help you as a parent to feel more confident and competent in case of a medical emergency.

Volunteer Opportunities at PLUK Main Office in Billings

Currently we have three volunteer positions needed at the PLUK main office in Billings. If you are interested in volunteering, please call Elizabeth Popp at 406.255.0540 or toll-free 800.222.7585.

Receptionist Volunteer

PLUK serves over 4, 000 individuals with disabilities and their families per year. On average, 80% of contact is over the phone. A volunteer receptionist's main responsibility will be to assist PLUK staff with providing service, referrals and information to their clients via the telephone as well as assisting with general office duties. Commitment is 4 to 8 hours per week. Number of volunteers needed: 4

Computer Lab Volunteer

PLUK houses an Assistive Technology Computer Lab that provides help for individuals with a wide range of cognitive and physical disabilities. A computer lab volunteer is needed to provide general assistance to individuals using the computer lab as well as assist the Assistive Technology Specialist with the Web site and PLUK publications. Commitment is 4 to 8 hours per week. Number of volunteers needed: 2

Library Volunteer

The TRIC/PLUK library is a health sciences library whose purpose is to provide access to disability related information. A Library Volunteer will assist with special projects assigned by the librarian. Commitment is 4 to 8 hours per week. Number of volunteers needed: 2

Remediating Sensory Processing Deficits

Occupational therapist Diana Henry has created videotape training manuals to help teachers, parents and children deal with the frustrations associated with sensory processing deficits. Her latest video, "Tools for Students," is a 30-minute interactive video aimed at enhancing the body-brain connection.

"Tools for Students" shows 26 interactive activities that can be used in the classroom and at home. Designed for children ages 4 to 13, the video is divided into two segments, which include descriptive visuals of each activity. Parents and teachers can start, stop and replay the video as they view this section with children, learning each activity together.

The 26 activities include: movement tools, muscle tools, position tools, writing/cutting tools, mouth tools, body tools, quieting tools and survival tools.

Henry based the tapes on her own teaching experiences and on occupational therapy exercises.

According to Henry, "Adults have fidget toys, desk toys, some doodle while on the phone, some listen to soft music while they're working--they're all accepted in the working world, even in the principal's office." Fidgeting and doodling appear to fill normal human sensory needs. Adults have license to fidget in the workplace, but children may not in the school environment.

Looking at the classroom from a sensory perspective, it is apparent that the standard "quiet" environment with children sitting in rows does not necessarily meet the sensory needs of all students. Some children need absolute quiet to learn, some work better while listening to music. Some children learn best when standing up or lying on the floor.

Henry suggests that the exercises she proposes can be easily integrated into the regular classroom and can help translate medical and therapeutic recommendations into practical uses in the educational setting.

To get more information on occupational therapy for the classroom, contact Diana Henry at 602.504.8788.