SD4 - Special Education in Virginia's Mental Health Facilities

  • Published: 1985
  • Author: Joint Legislative Audit and Review Commission
  • Enabling Authority: Senate Joint Resolution 13 (Regular Session, 1983)

Executive Summary:
State and federal laws entitle all children between the ages of 2 and 22 to a free public education regardless of their handicap or place of residence. These laws extend special education rights to children and youth residing in the Commonwealth's mental health institutions.

Senate Joint Resolution 13, passed by the 1983 General Assembly, directed JLARC to re-evaluate the quality of education programs in mental health institutions, as well as training programs in mental retardation institutions. Eight comprehensive issues, ranging from effectiveness of the administrative structure to quality of instruction, were included in the resolution to guide research.

In conducting its review, the JLARC staff was impressed with the competence, creativity, commitment of education staff, and a number of well-structured programs were observed. Three key problems, however, diminish the overall quality of the education programs:

(1) DOE and DMHMR have not provided adequate guidance, technical assistance, or oversight to the education programs, and coordination between the two agencies is lacking on both the administrative and institutional levels. This has resulted in a lack of comparable educational resources across institutions, and in education programs which differ greatly in quality. Thus, students are not receiving similar services across institutions.

(2) DOE and DMHMR have not fully acknowledged the special needs of older adolescents and young adults, and as a result this population is not served as adequately as the younger students in mental health institutions. Older students, by virtue of their age and handicaps, have strong needs for instruction in independent living and vocational education. However, comprehensive instruction is not offered to these students. Additionally, residential services for this group are inadequate.

(3) DOE and the education directors need to develop educational programs which are more responsive to students' emotional handicaps and which recognize the reasons students have failed in traditional classroom settings. Only VTCC implements educational programs which fully consider the students' emotional and social handicaps.

Administration of Programs (pp. 13-32)

The current administrative structure for operating and supervising MH education programs involves three entities: DOE, the local schools, and DMHMR. As implemented, the current administrative framework does not provide educational programs with sufficient support, supervision, and program guidance. Further, smooth administration has been hindered by insufficient communication among the institutions, DOE, and local school divisions, as well as between the central offices of DOE and DMHMR. The statutory responsibility for the education programs may need clarification by the General Assembly, since interagency agreements and contracts do not explicitly delineate each agency's specific roles and responsibilities.

Recommendation (1): The General Assembly may wish to amend Section 22.1-214 of the Code of Virginia to require the Board of Education to supervise educational programs for children in mental health institutions. (Current language only authorizes the Board of Education to supervise such programs.)

Recommendation (2): The Superintendent of Public Instruction should ensure that the educational programs in MH institutions receive more active supervision, guidance, and technical assistance. The position of Supervisor of Institutional and Related Services should be filled by DOE. This person should maintain regular contact with the institutions.

Recommendation (3): The Superintendent of Public Instruction should ensure that comparability of educational programs and services is not achieved by dismantling innovative and successful programs that cannot be duplicated at other institutions. Education directors should have a clearly defined role in assisting DOE to develop programs which are of comparable quality across institutions.

Recommendation (4): DOE should work closely with institutional education personnel, DMHMR, and local school divisions to ensure that the recently published draft of the "Administrative Manual For State-Operated Education Programs in Mental Health and Medical Facilities" fully addresses their needs for policy and procedural guidance. The manual should be promptly finalized and approved.

Recommendation (5): DOE should serve as a clearinghouse for relevant educational information. In this capacity, DOE program staff should make institutional education directors aware of the availability of federal requests for funding proposals.

Recommendation (6): To improve DOE's efforts to coordinate service delivery, DOE and DMHMR representatives should develop a letter of agreement specifying the types of services and assistance each agency will provide during the upcoming school year. This letter should be revised whenever either agency changes the type or amount of assistance provided.

Recommendation (7): The Commissioner of DMHMR and the Superintendent of Public Instruction should each appoint a representative who will be responsible for ensuring formal coordination of the two agencies in planning and implementing any proposed action affecting the institutional education programs.

Overall, DMHMR provides good educational settings. Significant problems with the quality of classrooms at Central State and DeJarnette, however, limit the effectiveness of instruction. Moreover, young adult students are housed with chronic adult residents, which also diminishes the degree to which these students may profit from instruction.

Recommendation (8): DMHMR should take steps to correct physical plant problems. Barriers to handicapped students should be identified and removed. DMHMR should expedite the renovation of building 1145 for relocation of Central State's school and explore alternatives for expanding DeJarnette's classroom space.

Recommendation (9): DMHMR should review its policy of housing young adults with chronic mentally ill adults. DMHMR should develop separate living areas for young adults as an incentive for school participation. These areas should have lower staff/resident ratios to provide a structured environment that encourages and complements involvement in educational programs.

Costs Incurred in Providing Services (pp. 33-44)

The Commonwealth funds 94 percent of the education costs at MH institutions, with the Federal government paying the six percent balance. The Commonwealth spent about $14.5 million in FY 1983 to provide comprehensive services to about 628 students in the six MH institutions. From this total, over $2.4 million was spent for institutional education programs in FY 1983. Another $364,000 was incurred in providing education-related services to youths. The final cost component funded by the State is the $11.5 million spent on residential and treatment services.

DOE needs to take a more active role in evaluating staffing levels. The result of inappropriate funding is a wide variation in the direct costs of education per pupil at the six facilities. The 70 students at DeJarnette and Central State received services valued at $8,744 per pupil-year, while the 22 VTCC students received services costing $14,044. The large difference is reflected in quality of service and needs to be minimized.

A similar situation exists with the overall costs of residential services and care. VTCC spends over $92,000 per pupil-year for all non-medial, non-educational expenses, while Eastern, Western, and Southwestern expend closer to $43,000 per person. VTCC's high costs for education and residential services reflect, in large part, underutilization of the institution.

Costs of $58,000 and $65,000 per pupil/year at Central State and DeJarnette indicate other potential inefficiencies: old, deteriorating buildings or high administrative costs at Central State, and a degree of underutilization at DeJarnette.

Recommendation (10): DOE should perform regular staffing level evaluations, and DMHMR should develop a policy to ensure that VTCC is used to its capacity in order to promote consistency in staffing and funding and to increase the availability of VTCC's services to eligible children.

Recommendation (11): DOE should devise a procedure to decrease the extreme variation in funding and services for residents across all six MH institutions.

Institutional Differences: Populations, Educational Resources and Staffing (pp. 45-64)

DMHMR and DOE have taken appropriate steps to differentiate the six mental health institutions by age and handicap levels. This has allowed education staff to develop specialization in educating certain types of students. However, inadequate attention has been given to matching resource needs to the different populations at each institution. Additionally, the availability of resources is not comparable across institutions.

Recommendation (12): DOE and DMHMR should assess the lack of comparability in resources and materials, in relation to the different educational handicaps at each institution. The assessment should be submitted for review by the Superintendent of Public Instruction. Particular attention should be directed to ensure:

(A) that all institutions have appropriate materials for academic instruction;

(B) that trained personnel and adequate resources are available to help staff meet the unique handicaps of young adults in the areas of independent living, pre-vocational education, and vocational education;

(C) that all students have the opportunity to participate in physical education; and

(D) that trained personnel and adequate resources are available to help staff address the emotional handicaps of students through educational instruction, such as art or music therapy.

Education staff hold appropriate certification for teaching emotionally disturbed children. However, few have specific endorsements in vocational education and art or music therapy. In addition, training opportunities for teachers are limited.

State regulations for student/teacher ratios (8:1) in mental health institutions are identical to those set for special education programs in the public schools. This appears inadequate given the greater severity of handicaps of students in the mental health institutions. This is recognized by DOE in funding more teachers than the minimum prescribed by State standards. DOE should formally review the appropriateness of the State requirement and adjust it.

Recommendation (13): DOE should encourage and support training activities for education staff, such as programs by DOE and DMHMR central office specialists as well as inter-institutional cooperation in training.

Recommendation ( 14): DOE should ensure that at least one teacher in each institution is endorsed in vocational education and art or music therapy. Financial support should be offered to teachers currently working at the institutions to receive these endorsements.

Recommendation (15): DOE should establish consistent procedures for the evaluation of education directors, and should review procedures which education directors use to evaluate teachers.

Recommendation (16): DOE should modify staffing requirements to more accurately reflect current staffing practices and population differences across institutions. In making this assessment, DOE should consider the severity of the students' handicaps and the variation existing between institutions in terms of: number and handicaps of students served, availability of resources and classroom space, and availability of resources and services provided by institution staff.

Program Development (pp. 65-84)

Curriculums at MH institutions are of uneven quality and are lacking in comprehensiveness and relevancy. Both DOE and the education directors are responsible for the curriculums, and should cooperate to improve them.

Recommendation ( 17): The General Assembly may wish to require in statute that DOE write and disseminate curriculum guidelines applicable to students in residential settings. In addition to academic programming, the guidelines should include independent living, vocational education, physical education, and affective education. Concurrently, education directors should improve existing curriculums by including interested teachers in the process and sharing curriculums across institutions.

A lack of consistent procedures across the six institutions characterizes the development of individual education programs. While programmatic strengths were observed, there were also significant problems. Five recommendations are offered to improve developmental processes and to ensure that all students receive educational services consistent with their handicaps.

Recommendation ( 18): Procedures for ensuring that school-aged residents are enrolled in school promptly after admission should be clarified at each institution and submitted to DMHMR for approval.

Recommendation (19): To ensure students receive assessments of similar quality, DMHMR and DOE should: (1) review assessment tools to determine their adequacy, and (2) ensure dissemination of assessments from treatment to education staff.

Recommendation (20): DOE should require public schools to provide information on students to education staff in institutions in a timely manner. DOE should ensure appropriate textbooks are available for each institution's long-term children and adolescents.

Recommendation (21): DOE and DMHMR should clarify the function of the IEP meeting and require that representatives from the treatment and education staffs participate in the finalization of students' educational programming.

Recommendation (22): Older students who are capable of providing input into the development of their educational programs should be encouraged to do so. These students should be consulted regarding the development of their educational programs and offered an opportunity to participate in some aspects of the IEP development process.

Recommendation (23): The IEP should serve as an accurate and understandable document to use as a basis for modifying a student's program and for guiding instruction. Education directors, monitored by DOE, should take steps to ensure the appropriate use of the IEP document.

Recommendation (24): DOE should provide in-service training or specific drafting guidelines, to ensure that goals and objectives are developed to provide a comprehensive and logical structure for students' programming.

All MH institutions have developed mechanisms for coordination, between the education and treatment staffs, of information on students. Interdisciplinary (ID) team meetings are used to exchange information. On a day-to-day basis, program coordinators or behavioral technicians serve as conduits between the education and treatment staffs. However, educators, and to a lesser extent treatment staff, believe that communication between staff is inadequate. This diminishes the overall quality of education, since the education and treatment staffs are not fully informed of each other's efforts in promoting the emotional and educational achievements of students.

On-going communication with parents is also important. However, only VTCC and Eastern have mechanisms for transferring information about students. Many (21%) students in MH institutions are essentially wards of State agencies. To ensure that these students have an advocate, all institutions are required by law to implement a surrogate parent program. Only Eastern has done so.

Recommendation (25): Education and treatment staffs at all institutions should ensure that the continuity of services is maintained by coordinating information about each student's schedule (i.e., IEP and treatment planning conferences, appointments requiring the student's absence from class) in a timely manner.

Recommendation (26): Staff at MH institutions should initiate policies to ensure that information concerning students' educational and emotional progress is communicated to parents on an on-going basis. DMHMR should review parent-outreach and discharge procedures to ensure parents' knowledge of their children's progress. DMHMR could work with Community Service Boards in this effort.

Recommendation (27): Every MH institution should comply with the law and establish a "surrogate parents" program. DOE should monitor this program and report on its implementation at the 1986 session of the General Assembly.

Quality of Instruction in Academic and Vocational Education (pp. 85-104)

The availability of academic resources is uneven across MH institutions. Availability at VTCC is superior to those at other institutions. Differences are most pronounced in computer-assisted instruction. While computer-assisted instruction is emerging as an effective tool for the education of emotionally-disturbed children, only VTCC has adequate software and staff expertise to use computers. As noted previously, the classroom environments at Central State and DeJarnette are inappropriate for instructional purposes. Attention by DOE to resource disparities and curriculum development would contribute to enhanced quality in academic instruction. Other improvements would result from technical assistance offered by DOE to education staff at Central State, DeJarnette, and Western.

Recommendation (28): DOE should take steps to specifically assess the availability and quality of text and workbooks, and to supply materials to institutions in areas where they are lacking. Since appropriate textbooks and workbooks for this population are difficult to locate, DOE and education staff should compile and disseminate lists of available texts. Education directors should employ this list in considering future purchases.

Recommendation (29): Computer-assisted instruction appears to be a viable and effective means of teaching emotionally disturbed children. DOE should support education staff in their recent initiatives to utilize computers. DOE should aim to equip institutions, in terms of availability of resources and trained staff, at the standard set by VTCC. DOE should ensure that students across institutions have access to computer-assisted instruction. To increase the utilization of computers currently owned by education staff, education directors and DOE should ensure that some teachers at each institution develop expertise with available software packages.

Recommendation (30): DOE and DMHMR should take steps to ensure that services in speech therapy are available, as needed, to Central State's students.

Recommendation (31): The education director at Central State, assisted and monitored by DOE, should take the following steps to improve the quality of academic instruction: (1) develop an academic curriculum; (2) clearly structure teachers' daily instruction schedules to ensure that students receive comprehensive academic programming; and (3) ensure that academic goals are documented and updated in the IEP in all areas of instruction.

Recommendation (32): The education director at DeJarnette, assisted by DOE, should take the following steps to improve the quality of academic instruction, particularly within the adolescent program: (1) upgrade the academic curriculum to reflect the special needs of emotionally-disturbed adolescents; (2) more clearly structure teachers' daily instructional schedules to ensure that children and adolescents receive comprehensive programming; and (3) solicit the assistance of staff at VTCC, Eastern, and Southwestern to generate ideas for improving the quality of education for adolescents.

Recommendation (33): The education director at Western, monitored by DOE, should take the following steps to improve the quality of academic instruction for higher-functioning young adults: (1) organize their "library or programs" into a unified curriculum; (2) clearly define the roles of coordinators and teachers; (3) rearrange the use of classrooms to ensure that students can engage in academic instruction in an environment which is conducive to that type of learning; and (4) document and upgrade academic goals in all areas of instruction in the IEP.

The majority of students (79%) in MH institutions are adolescents and young adults. The emotional and behavioral handicaps which limit their ability to learn in academic settings also interfere with performance in vocational and daily living settings. Educational instruction, with the goal of promoting vocational and independent living skills, is especially important for older students. These students, as they reach the legal age of maturity, are presented with the immediate task of functioning independently as adults, after their release from the institution. It is to these students' benefit, therefore, that they develop vocational skills. It is also in the financial and social interests of the Commonwealth. If these skills are not developed, the older students are less likely to be productive in the community, and are more likely to spend significant periods of adulthood in State-operated residential facilities.

Central State has excellent resources for vocational education and provides instruction to most of their older population. In comparison, staff at Eastern, Western, and Southwestern which serve comparable students, cannot provide instruction to all eligible students due to a lack of resources. Similarly, VTCC has a variety of program offerings in computer literacy for younger students, However, DeJarnette, with a similar population, has no resources for vocational education.

While older students typically lack "marketable" job skills, education staff also noted that this population is unable to keep jobs because of their inability to "get along" with their employers. Pre-vocational training designed to assist students in developing job-related social skills and in strategies for finding jobs is thus important. While education staff are beginning to develop prevocational programs, they are not emphasized for the older students. This diminishes students' abilities to become independent adults.

Recommendation (34): DOE should provide written guidelines specifying standards for educational programming in vocational education for adolescents and young adults.

Recommendation (35): DOE should take steps to ensure that all young adults, and adolescents who are expected to remain institutionalized for a period of over three months, receive vocational instruction. Two complementary directions should be explored and implemented: (1) DOE and DMHMR should ensure that all institutions are equipped with appropriate resources for vocational education; and (2) DOE should develop a policy to recruit qualified staff and encourage teachers to attain endorsements in vocational education. Consideration should also be given to having the institutions develop job placements in the community for students who successfully master vocational skills.

Recommendation (36): DOE, in association with education directors, should develop curriculums for pre-vocational instruction. Curriculums should specify goals and outline the types of experiences which students need to develop pre-vocational skills.

Recommendation (37): DOE should assess the availability of pre-vocational materials at all institutions. DOE should ensure that all institutions have comparable and adequate resources.

Recommendation (38): As noted earlier, some education staff should have endorsements in vocational education. This endorsement reflects training in assessing pre-vocational needs and designing appropriate programs. Where appropriate, pre-vocational instruction should be incorporated into current vocational and academic course offerings. Pre-vocational goals and objectives should be written in students' IEPs and updated.

Most students have severe handicaps in independent living skills which interfere with the ability to function outside the institution. Instruction in independent living is a shared responsibility of the treatment and education staffs, yet programs are not coordinated between the two staffs. Western has been most successful in incorporating instruction in independent living into academic programs; however, staff at all facilities noted that training is most appropriate in settings which simulate home environments. At VTCC and Southwestern, educators stressed that the living units were suitable settings for this purpose. At other institutions, however, educators expressed a need for more "normalized" settings to provide instruction in independent living.

Recommendation (39): Treatment and education staff at all institutions should take steps to communicate information and coordinate instruction in independent living.

Recommendation (40): Programming in independent living is inconsistently implemented so that residents with similar handicaps do not receive similar education. DOE and education directors should develop guidelines for incorporating instruction in independent living into educational programming.

Recommendation (41): During institutionalization, it is essential that all students have opportunities to participate in community activities. Given the social handicaps of this population, these activities should address specific education objectives and should be included in the IEP.

Recommendation (42): Every student should have access to a physical setting which resembles a "normalized" home environment, specially-equipped for opportunities to improve daily living skills. To provide this opportunity, DOE and DMHMR should (1) assess the availability of independent living resources in the institutions; (2) identify and secure the types of resources in the institutions; (3) consider restoring the vacant houses which exist on Eastern's and DeJarnette's grounds to provide instruction in independent living.

Quality of Instruction in Physical and Affective Education (pp. 105-118)

As noted in P.L. 94-142, physical education, if carefully implemented, can be used to address students' physical, emotional, and social handicaps. In MH institutions, however, educational goals for physical education are not consistently written for students, indicating that instruction is not emphasized as an educational activity. In addition, staff at three institutions reported that physical therapy was not consistently available to those in need of this service.

Recommendation (43): Central State and DeJarnette cannot provide adequate physical education courses because of limited facilities. DMHMR should take steps to provide physical education to students at these institutions. For example, arrangements could be made for DeJarnette's students to use the gym at Western, or public school facilities. Arrangements with public schools or community YMCAs could also be made for students at Central State.

Recommendation (44): Education staff and DOE should provide guidelines to address the ways in which physical education may be incorporated into students' overall education programs, and reflected in the IEP.

Recommendation (45): DMHMR and DOE should clarify policies to ensure that physical therapy is provided as necessary by institution staff or consultants. Teachers should be provided training to work with mild physical handicaps, and appropriate resources should be made available.

Students are admitted to mental health institutions because of severe emotional and behavioral handicaps. These handicaps limit students' abilities to function effectively in the classroom, as well as in home and work environments. While institutional staff provide treatment through clinical experiences, education staff may offer instruction in affective education. The need for affective education is reflected in the overall education goals set out by DOE. For example, to "develop a positive and realistic concept of self and others" is one of the seven expectations that DOE has for students in residential settings and is identical to the goals of affective education.

The JLARC staff was impressed with the educators' knowledge of their students and the ways in which they modified instruction to address emotional handicaps. However, structured classes specifically designed to enhance the students' sense of competency or self-esteem are not consistently offered. For example, art and music are traditional forms of affective education, yet only VTCC offers instruction in these areas to all students. Additionally, problems were apparent in the behavior management systems employed at three institutions.

Recommendation (46): DOE and education directors should clarify the role of affective education in the context of students' overall instruction. Curriculums and guidelines should be written and disseminated to provide guidance for developing affective education programs.

Recommendation (47): Since art and music therapy appear to be important tools to address both emotional and educational handicaps, all students should have the opportunity to receive this type of instruction. DOE should ensure that qualified staff and appropriate resources are made available to education directors.

Recommendation (48): Education staff have access through institutional facilities to some art and music resources. Education directors should determine how they can incorporate these resources into their students' overall program and take steps to do so.

Recommendation (49): DMHMR, with the assistance of treatment and education staff, should review the behavior management systems at all institutions to ensure coordination and consistency among education and treatment staff members.

Recommendation (50): Education directors should specify behavioral objectives for students, and should fully discuss these objectives with staff members to enhance consistency. Behavioral objectives should be included in the IEP.

See the full report for additional recommendations.