Why a Doctor’s Note is not the IEP Slam Dunk you Think it is.

I won’t ever forget the interaction I had with one of Kevin’s neurologists. We had a regular appointment/checkup. And he was a baby, like 2 years old. We knew he was autistic and I wanted him in an ABA program.

The neurologist said to me, “Just tell them that he needs ABA.” And he offered to write me a letter stating as much. I still have it. And I was sure that I had struck gold! I had an IEP letter from a doctor! Score!

I still have the letter and date on it tells me that this was when he was still in 0-3 services. So, not an IEP, but still….

My School District is Ignoring my Doctor’s Note!

Kevin did attend a verbal behavior preschool classroom. But, it wasn’t our doctor’s note that got him there.

It’s a common complaint. You got your note from your doctor supporting whatever request it is you want from your IEP team, and they still said no.

Do IEP Teams have to honor Doctors’ Notes?

ABA wasn’t even something I think was available back then, in a 0-3 program. But I thought I definitely had it made.

All I had to do was present this to his coordinator…and those special education services would just start flowing our way. Right?

Now when I look back on that incident and my naivete, I want to face palm.

Are there IEP laws about Doctors’ Notes?

So, the short answer here is…there is no short answer. When it comes to some accommodations, such as those for life-threatening food allergies, seizure plans, and Type 1 Diabetes, yes, a doctor’s note will get you those accommodations.

In fact, it is best practice to bring in said allergy or seizure plan from your doctor and present it to your team. My son’s school actually requires that his seizure plan be updated by his neurologist every year.

To give you some framework, try to think of it this way. If my son has a seizure and the seizure plan is not followed, what may happen? If your child has a life-threatening allergy, comes into contact with an allergen, and the plan is not followed, what may happen? What will happen if a child does not receive insulin?

They may die. So before you think about trying to sway your IEP team toward adding something to your IEP, ask yourself that question. “Will they die if they do not receive this?”

Chances are, no. Also ask, is this a medical or educational support/service/accommodation?

Even still, believe it or not….I have seen many schools refuse to honor doctor-requested accommodations for life-threatening food allergies. I cannot imagine that a school district would want to take on that kind of liability, especially when the food and T1 accommodations I’ve seen are so minimal.

I know! It’s crazy! But it does happen. I often wonder if the special education director has told the school district’s solicitor that they are doing this. Or maybe the special education director even knows that it’s happening.

Do IEPs have to Honor Doctor’s Notes?

Most of what I hear from clients and in our chat group is not life and death situations.

Parents often (mistakenly) think that a doctor’s note will secure them:

• a 1:1 aide or special education paraprofessional
• ABA therapy
• increased supports and services on an IEP, such as increased therapy time

And that’s not how this works. At least not in a direct cause/effect fashion.

Can a Doctor do IEP Evaluations?

IEP teams are required to consider outside evaluations. So, I would treat this as such.

When it comes to IEP evaluations, we most often think of someone sitting with our child and administering either written evaluations and standardized assessments. This is not something defined by IDEA–evaluations. What I mean is, nowhere in IDEA does it say that a visit to a clinician is not an evaluation.

You can treat it like an IEE. Yes, a doctor can assess how a condition or symptom may affect a child’s education.

However, that will require that your child’s doctor’s office write more than a few sentences. I would ask that the doctor, the PA or whoever is assisting them, to fill out comprehensive visit notes.

Many practices then have this available for caregivers online, and you can just print them out.

This should include:

• Brief history of the child
• What they were seen/evaluated for on that particular visit
• Recommendations

Then, it can be treated an an outside evaluation and submitted to the IEP team for consideration. Like any other IEE, the team does only have to “consider” the information.

But, should you choose to use your IEP Procedural Safeguards, this evidence will strengthen your request.

But this is their appropriate education.

Schools do not have to follow doctor’s orders. If you believe in the soundness of the doctor’s note and that this is FAPE for your child, I would continue on with the IEP process. Meaning, use it as an IEE report.

IEPs are needs-driven. If you want something added to the IEP, you have to demonstrate need.

This happens either through evaluations, or team decisions based upon the IEP progress monitoring that is being done.

If a child is not making adequate progress toward IEP goals, and can reasonably be expected to do so, then you’d add more in to address that specific need.

The three steps to follow are pretty simple:

1. Parent makes a written request for said support or service.
2. Team discusses it; school ultimately makes final offer to parent.
3. Parent receives that decision on PWN and decides whether or not to use her procedural safeguards.

It’s also very common when a child has a medical diagnosis of autism or ADHD, but the school does not feel the child needs an IEP. You still must go through the process and request IEP evaluations.

Modifying an IEP Based on Doctor Recommendations

In the IEP process, for most situations, a doctor’s note is considered an outside evaluator’s report.

And, per IDEA, they only have to “consider” the information presented to them in such a report. Whatever you submit to your IEP team should demonstrate an educational need.

A doctor’s note supporting your IEP request may work, but it is not the slam dunk that many parents think it is.

Whenever you make a request, you want to have as much supporting data as you can. A doctor’s note stating that your child needs a 1:1 or more OT is just one piece of data in the big picture.

If it works or has worked for you, great. I mean that. If it was up to me, all of kids would have their needs met and this website would disappear. But just because it worked for you doesn’t mean that it’s a slam dunk for every other child. And, parents need to have reasonable expectations.

I have heard from many parents who got a doctor’s note, demanded something on the IEP because of it, and then were furious and/or disappointed when it didn’t happen.

Fact is, it shouldn’t happen.

Imagine the chaos in the IEP system, if all parents had to do was get a doctor’s note! We really don’t want doctors dictating what happens in the IEP process.

Again, use the IEP process and use your Procedural Safeguards. As always, ask in our chat group if you have further questions.