Options for School in a Pandemic

Most families are struggling to help their children continue their educations during the COVID-19 pandemic. This is especially true for children with complex medical conditions or disabilities, who may be at higher risk of medical complications from COVID-19. Education during a pandemic is also challenging for children with a wide range of learning challenges, behavioral problems, or other disabilities, who may struggle in both virtual and socially distanced schooling situations.

In this article, we will discuss how to make decisions about schooling, your child’s presumed legal rights, and tips for remote, in-person, and hybrid learning during these times. Note that there is currently not always an easy answer to what is legal and what is not, and the answer may vary by state. Nonetheless, we will try to provide answers to the best of our abilities, given the currently available information.

Making the Decision: In-Person versus Remote Schooling

The first decision you need to make is whether you believe it is safe for your child — and potentially your child’s siblings — to return to in-person schooling, if that is an option in your area. There are three broad categories you need to consider in making your decision: your child’s individual medical condition, your community’s amount of COVID-19 spread, and your school’s plan to mitigate or minimize COVID-19.

Please note that this is not likely a one-time decision. Some states are currently seeing improvement while others are worsening. We don’t know what will happen this winter as people are spending more time indoors and cold and flu season hits. Families will need to revisit this decision repeatedly as case rates change and as treatments or vaccines begin to emerge.

Your Child’s Medical Condition

COVID-19 affects people differently based on a wide range of factors including but not limited to age, cardiovascular health, immune function, and underlying condition. Some children are more prone to COVID-19 complications, including potentially death. Common conditions that appear to be riskier include:[1]

• Children who are medically fragile, especially if they are technology dependent
• Children with serious lung conditions
• Children with heart defects or cardiovascular compromise
• Children with intellectual disabilities, especially with concurrent physical or health disabilities
• Children with neurological conditions
• Children who are obese
• Children with immune system problems, including autoimmune disease, immune deficiency, and immune suppression
• Children with blood disorders, including cancer, especially if immune suppressed

If your child has one of these conditions, we recommend you share the decision making process with a medical professional you trust to determine how safe in-person schooling is for your individual child. This might be your pediatrician, a specialist, a complex care or palliative care physician, or a nurse who works closely with your child. Note that you may want to discuss your individual situation with multiple medical professionals since each may have a different base of knowledge regarding COVID-19.

You should also consider your child’s individual ability to comply with strategies to mitigate COVID-19, such as mask-wearing, socially distancing, and hygiene. Children who are unable to wear a mask or face shield and have difficulty with social distancing may be safer learning remotely.

COVID-19 Spread in Your Community

In addition to your child’s individual risk, it is important to determine how COVID-19 is affecting your region. First you need to find a reliable source of information about your state, county, or city. The best place to start is with your state’s public health department or division. Most have some sort of dashboard that lists statistics for your region. You may also find this information on a city or county-based public health page in some areas.

You will likely find something like this, which is a snapshot of the information for Chicago:

Some of the important metrics you may want to look for include the following for your city or county:

• Positivity rate, or the percentage of positive tests (assuming adequate testing)
• Daily or 7-day case rate per 100,000 people
• Increase or decrease in confirmed cases

While there are no defined cut-off points issued by the federal government for any of these metrics, some states or cities do have individual cut-off points. For example, in Illinois the state recommends a positivity rate below 5, less than 50 new cases per 100,000 people, and decreases in both overall and youth cases on a county-wide basis.[2] On the other hand, Arizona recommends a two week decline in cases or less than 70 cases per 100,000 people, less than 7% positivity, and less than 10% of hospital visits related to COVID-like illness.[3] Pennsylvania recommends rates of 100 cases per 100,000 in the past seven days and a 10% positivity rate as the cut-off for moving to full remote instruction.[4]

School Mitigation Measures

The final factor to consider is your individual school or district’s plan for bringing children into the classroom. Some of the factors you may want to consider include:

• Masking policies for students and staff
• Social distancing strategies
• School ventilation system
• Number of children in each classroom or area
• Hand-washing and other hygiene plans
• Personal Protective Equipment availability for adults who must physically interact with your child (such as nurses, aides, or therapists)
• Symptom screening plan (such as self-certification or temperature checks)
• Use of pods or cohorting
• Busing or other transportation plan if applicable

A strong, robust plan by a school or district should include details for all of the above factors, and should, at minimum, include masking, social distancing, and appropriate hygiene and ventilation in all communities with any level of COVID-19 spread.

Tips for Full Remote Schooling

If your school district is currently fully remote, or you have the option to choose for your child to be fully remote, we have a variety of tips to help improve your child’s experience. First off, we all need to recognize that remote schooling is new for most teachers and families. There will be bumps, and there will be new issues that will need to be addressed.

Remote education is currently being handled in several different ways, all of which are options to consider. The first is a school- or district-directed remote learning environment, which typically consists of a full or partial day delivered virtually over the internet with live instruction for much of the time period. Next, some schools are outsourcing education to a range of pre-existing online schooling programs, which may include live instruction, self-paced work, or a combination. Finally, some families are choosing to homeschool their children on their own or with a hired professional, with or without assistance from the local school district.

For families using a district-provided program, your child’s IEP is legally fully in effect whether your child is schooling in-person or remotely. It is likely the IEP will have to be adapted for remote learning; however, this does not mean your child should have aspects of the IEP, such as therapies or classroom assistance, removed from the IEP. Instead, your school should create a remote learning plan for your child based on his or her current IEP or 504 plan. This plan should include how special education minutes will be provided virtually, how therapy and other related services will be provided (virtually or in-person), and how aides will work directly with your child. Do not allow your school to bully you into diluting or otherwise eliminating aspects of the IEP, including permanently changing the section on the Least Restrictive Environment. At the same time, understand that flexibility and creativity are likely to be needed to find solutions to problems that occur.

The American Academy of Pediatrics recommends that students with IEPs who receive aide, nurse, or therapy minutes should continue to receive these at home, and that they should be provided in-person if safety permits. For example, if your school district normally pays for a 1:1 nurse during the school day, your school district should continue to pay for that 1:1 nurse at your home during remote schooling hours. Similarly, an in-person aide using proper personal protective equipment may also be appropriate for many children, and in-person therapy services may also be helpful. Some districts in areas with tremendous community spread cannot allow in-person aides or therapists, but in areas with less COVID-19 spread, it should be allowable if it can be done safely. If any students in the district are attending in-person, the school should definitely be providing in-person therapists and aides to students learning remotely if desired. Schools should also provide positioning and assistive devices to be used in the home, including communication devices.

IEPs may need to be adapted significantly for those unable to access the curriculum in a typical remote fashion. Students may need sensory breaks added, additional communication strategies employed (such as typed text, captions, or ASL for deaf students), or new methods of meeting individually for extra assistance.

In some school districts, virtual schooling is being outsourced to preexisting remote learning platforms. Note that your school still must comply with your child’s IEP even if they are outsourcing. If the outsourced platform is inappropriate for your child, you can request a different one or a different type of learning, such as homebound instruction with a tutor.

Students who typically receive homebound services in their homes should continue to receive these services. Most students receive 1-4 hours of individualized instruction from a tutor in the home and may also receive therapy services. In some districts, homebound can continue in-person, but in other districts it must be delivered remotely. It still may be advantageous to have homebound instruction virtually for your child even if all services in your district are being delivered remotely, as some students do better with a short period of 1:1 tutoring. Some districts are requiring homebound students be placed into regular remote classes; however, if the time or pace of these classes cannot meet your child’s needs, an alternative can and should be found.

It is important to discuss with your school the option for later compensatory education to make up any services that could not be delivered appropriately during the pandemic. Keep track of compliance with your child’s IEP and make sure the school and district are aware of gaps.

Finally, if at all possible, make sure all siblings of the child who is medically complex or has a disability are also schooling in a remote setting. The American Academy of Pediatrics has recommended this option be available to families.

Tips for Hybrid Schooling

Hybrid learning may be an option in some districts. In most models, students are grouped into pods or cohorts that attend for part of the day or on alternating days. In general, these strategies are not particularly useful for children who are medically complex, as the risk reduction from cohorting is unlikely to substantially reduce their exposure to COVID-19, especially if they require childcare at times when they are not at school. In addition, hybrid schooling may be very challenging for students who thrive on daily routine.

However, there is definitely a place for schools to provide in-person special education services in the school building when those services cannot be provided at home. We encourage schools to prioritize special education populations by first returning high-risk populations to the building. Services should be provided in small, socially distanced groups with appropriate personal protective equipment for all.

Tips for In-Person Schooling

If your school district is mandating in-person schooling, know that you still have options. Your physician can write a letter of medical necessity requesting homebound services for your child based on his or her medical condition. In this situation, your child should receive in-home homebound tutoring in the standard manner, usually 1-4 hours per day. This option is sometimes preferable, especially if schools are offering both in-person and remote options and the remote option is outsourced. In addition, homeschooling is always an option.

If you do decide to send your child to school, make sure that services, especially hands-on services, are safe for your child. Aides and therapists should don comprehensive personal protective equipment, which may include a mask, face shield, and gloves, when caring for your child.

Note that in most states students who cannot wear masks due to developmental challenges (and in rare cases students who are unable to wear masks due to respiratory or safety issues) cannot be denied an in-person education if their school is offering one. The school will need to develop a plan to safely protect your child, the other children, and the staff.

Students with complex medical conditions and disabilities should be prioritized by schools and be placed in classrooms with better ventilation and the ability to social distance whenever possible.

Finally, remember that in-person schooling is likely to look very different as well. Your child may need adaptations of his or her IEP even in an in-person setting to confront changes and concerns related to COVID-19.

Where to Get Help

It is likely that individual issues will crop up that are challenging to handle. The following resources are helpful in addressing individual problems and concerns:

• Wrightslaw (special education guidance)
• Parent Information and Training Centers (special education advocacy assistance)
• Protection and Advocacy Organizations (disability and special education legal services)
• American Academy of Pediatrics Guidance on Children with Special Health Care Needs and COVID-19

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[1] See https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people for condition-specific recommendations in the UK.

[2] http://dph.illinois.gov/countyschool?county=Adams

[3] https://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/novel-coronavirus/covid-19-school-benchmarks-county.pdf

[4] https://www.education.pa.gov/Schools/safeschools/emergencyplanning/COVID-19/SchoolReopeningGuidance/ReopeningPreKto12/Pages/DeterminingInstructionalModels.aspx