International DPHD Position Paper on
Critical Need for
Physical/Health Disability Certification
The Division for Physical and Health Disabilities of the Council for Exceptional Children (CEC) maintains that there is a need for states to have a certification category in Physical/Health Disability (also referred to as Orthopedic Impairment and Other Health Impairment). On a national level, there are 60,604 students categorized as having orthopedic impairments and 106,509 students with other health impairments. In addition to these students, there are 9,646 students who are categorized as having multiple disabilities how often have physical disabilities. This is a growing population. For example, the number of students with orthopedic impairments alone has increased each year over the post four years for an overall increase of 22.8% (US Department of Education, 1996).
Students with physical disabilities may have a wide range of physical conditions that can negatively impact on their educational performance. Students with conditions such as severe spastic cerebral palsy may be unable to talk or functionally use their hands. Progressive degenerative conditions such as Duchenne muscular dystrophy result in a progressive loss of movement, increasing fatigue and an early death in the school age years. Some physical conditions typically result in the student requiring certain specialized health care procedures such as students with spina bifida usually needing clean intermittent catheterization during the school day. Students with health disabilities may have such conditions as cystic fibrosis, end stage renal disease, or respiratory problems that require the use of a ventilator in order to breathe. These students have unique educational needs that require teachers who are trained in specialized knowledge and skills to appropriately meet their students' needs.
As of December 1, 1996, 17 states have a specific Physical/Health Disability (or Orthopedic Impairment) certification category. Five additional states have certification in Physical/Health Disability of Orthopedic Impairment, but students served under these categories may be taught by teachers who have certification in other areas. Twenty-eight states have no certification in Physical/Health Disabilities or Orthopedic Impairments. In 1997, at least two states that currently have certification in Physical/Health Disabilities or Orthopedic Impairments are considering deleting this category (Williams & Heller, 1996).
SPECIALIZED SKILLS IN PHYSICAL/HEALTH DISABILITIES
Students with physical/health disabilities often have multiple educational, technological, and health care needs that require the teacher to have specific knowledge and skills to provide an appropriate education. Of all of the groups of specific populations of students with disabilities who require teachers to have specialized training to meet their needs, students with physical/health disabilities are the most at risk if the teacher does not have the required knowledge and skills. Not only is the student at risk of not having an appropriate education with the necessary modification and adaptations, but the student's physical well being may be at risk. The child's physical well being may hinge on the teacher's knowledge and ability to: a) provide a safe environment to accommodate the students unique medical and health needs, b) recognize and report critical observations concerning changes in health status, and c) recognize and respond quickly to emergency situations.
There are many unique skills that teachers need to possess to appropriately teach students with physical/health disabilities. Teachers certified through an accredited comprehensive program in physical/health disabilities receive instruction in these skill areas. This enables these teachers to provide appropriate service to students with physical/health disabilities, whether through direct service to the student and/or consultation to the classroom teacher. These skills are delineated in "What Every Special Educator Must Know: The International Standards for the Preparation and Certification of Special Education Teachers" (The Council for Exceptional Children, 1996), under CEC Knowledge and Skills for all Beginning Special Education Teachers of Students with Physical and Health Disabilities. Some examples of these unique skills in each major category are as follows:
LEGAL FOUNDATIONS
Teachers should know specific laws and policies related to the provision of specialized health care in the educational setting (e.g., knowledge of conditions for referral related to health status, knowledge of responsibilities for suctioning tracheostomies, maintenance of health records).
CHARACTERISTICS
Teachers of students with physical/health disabilities should have knowledge of the unique characteristics of physical/health disabilities to make appropriate recommendations on the adaptations and information needed to meet the students' needs throughout the school day (e.g. determine how to schedule the school day for a student who fatigue easily; teach other school personnel seizure management techniques).
ASSESSMENT
Teachers of students with physical/health disabilities should have the ability to recommend modifications to assessment instruments or procedures to appropriately determine a student's knowledge, as well as have the ability to develop specialized assessments and integrate results into instruction (e.g., determine most reliable method of response modifications for evaluation).
INSTRUCTION
Teachers of students with physical/health disabilities should have the ability to determine appropriate instructional modifications and effective use of adaptations and assistive technology (e.g., determine how to modify reading and spelling instruction to teach a nonverbal student to read and spell).
CURRICULUM
Teachers of students with physical/health disabilities should have the skills to expand the students' curriculum beyond their academic curriculum to include specific training and adapted procedures in areas such as independent living skills, vocational skills, medical self-management, health care procedures, modification of computer access and use, programming and use of augmentative communication devices and other assistive technology devices as appropriate for each individual student.
LEARNING ENVIRONMENT
Teachers of students with physical/health disabilities should be able to coordinate the learning environment (e.g., integrating health care plans into daily programming, coordinating activities of related service personnel and paraprofessionals, monitoring effects of medication, using adaptive equipment, promoting safety on the playground and in the community, and positioning to maximize participation in instruction and activities).
COLLABORATIVE PARTNERSHIP
Teachers of students with physical/health disabilities should have skills in collaboration with related service providers and families in such areas as assistive technology, health care procedures, curricula, and strategies to work with chronically ill and terminally ill individuals an their families.
PROFESSIONALISM
Teachers of students with physical/health disability should have skills to assist with integrated care, particularly when transitioning the student from home, hospital, or rehabilitation facility.
STATE CERTIFICATION
Many state licensure unites are supporting the generic, noncategorical, or mild/severe tracks and reducing the traditional categorical tracks. This results in a failure to meet the specialized needs of students with physical/health disabilities, since the sampling of skills described above are not commonly addressed by teacher preparation programs for students in generic, noncategorical, or mild/severe tracks. Just as teachers certified in visual or hearing impairments possess a body of specialized knowledge specific to their disability area, so must teachers of students with physical/health disabilities be trained in specific competency areas. The Division for Physical and Health Disabilities of CEC urges states to maintain or institute distinct and separate professional certification for physical/health disabilities as a professional certification category. This will help assure that students with physical/health disabilities are provided appropriate services by teacher who have the specialize knowledge and skills to meet their needs.
REFERENCES
The Council for Exceptional Children (1996). What every special educator must know: The international standards for the preparation and certification of special education teachers, Second Edition. Reston, VA: Author.
U.S. Department of Education (1996). To assure the free appropriate public education of all children with disabilities: Eighteenth annual report to Congress on the implementation of the Individuals with Disabilities Education Act. Washington, DC: Author.
Williams, S. & Heller, K.W. (1996). (Certification across states in physical/health disabilities). Unpublished raw data at the time of publication of this position statement. For published data see: Heller, K.W., Dykes, M.K., Best, S. & Cohen, E.T. (1999). A national perspective of competencies for teachers of individuals with physical and health disabilities. Exceptional Children, 65, 219-234.