How Clinicians Can Partner with Schools to Support Pediatric Patients
- January 30, 2025
- The REACH Institute
- Child mental health, Parents, Patient communication, Pediatric primary care

“Clinicians who are aware of and know how to direct parents to obtain services for children within the school system can make an enormous difference for patients and families,” explains Dr. Mark Wolraich, MD, a REACH faculty member and retired professor of pediatrics at the University of Oklahoma Health Sciences Center.
The challenge for clinicians and families, however, is that different schools and school districts may operate quite differently. Some are responsive and proactive while others lack adequate resources.
We asked Dr. Wolraich and child and adolescent psychiatrist Dr. James Wallace, MD to shed light on how school-based interventions and accommodations work, what the law requires, common challenges, and how providers can build productive relationships with local schools and school districts.
First Step in Securing School-Based Services: Parental Request
The process for securing school-based services can vary by school and by school district. However, in most cases, the first step is for the parents to write a letter to the school requesting an evaluation for their child.
This letter must come from the parents, not the clinician. But clinicians can support parents in preparing the letter by helping them best describe their child’s symptoms and needs. Some clinicians even prepare a template letter that parents can easily adapt.
Once the parents have submitted the letter, schools initiate the process to assess students’ needs. Under the IDEA or Individuals with Disabilities Education Act (formerly known as Public Law 94-142), public school districts must do a multimodal team assessment, have a Committee on Special Education (CSE) meeting, and determine if the student fulfills one or more of 13 defined classifications of problems that interfere with learning. For example, this includes specific learning disabilities, intellectual disability, and autism spectrum disorder. Read about the 13 disability categories recognized under IDEA here.
Legally, the school’s assessment must occur within 60 days, though some school districts may be overwhelmed due to demand and limited funding. In these cases, it can be helpful for parents to understand the law and what schools should be doing, so they can be more effective in advocating for appropriate services.
Note that private schools do not have the same requirements as public schools. Charter schools are required to follow federal laws but may have different state exemptions or requirements depending on whether or not they receive federal funding.
The Two Primary Types of School-Based Plans
Based on the school’s assessment, students may qualify for two primary school-based plans under different legal frameworks.
- IEP or Individualized Education Program: If the school determines that a student’s disability falls within the 13 predefined categories that interfere with learning, the school must develop an Individualized Education Program or IEP. This is part of Special Education and schools receive extra federal funding to provide services.
- 504 Accommodation Plan: A 504 Accommodation Plan is part of a civil rights law (section 504 of the Civil Rights Act) mandating that schools make reasonable accommodations to “level the playing field” for students with disabilities. This is part of General or Regular Education and schools do not receive extra funding for 504 plans. A child with any disability that affects their learning, including mental health disorders, can qualify for a 504 plan.
As part of the assessment and plan development, with parents’ permission, clinicians can share reports about the child’s conditions and recommended interventions with schools. Some school districts have even created “permission slips” for information sharing that address patient privacy under HIPAA and Family Educational Rights and Privacy Act (FERPA) protections.
Common Accommodations for Mental Health Conditions
Under 504 plans, Dr. Wallace explains that “school accommodations can be simple and informal – sit up front, wiggle seat or strap, call on often, team up with strong student – or more complex – extended time for quizzes and tests, a quiet setting for quizzes and tests, weekly help organizing backpack and locker, agenda check to be sure assignments are written clearly.”
Historically, the most common disability addressed through a 504 plan is ADHD, but schools are using 504 plans in newer ways to address anxiety disorders and depression.
However, Dr. Wallace cautions that there is no strong research to tell us which accommodations for which disorders are most helpful, or how and when to consider tapering them throughout development. One concern is the risk that overaccommodation, especially for conditions like anxiety, might worsen impairment and stifle the development of future life skills. For example, accommodating a student with anxiety by giving them the option to present to their teacher (instead of in front of the whole class) could reinforce avoidance of giving presentations. However, temporarily offering this accommodation as the student learns to face his/her fear could be helpful.
Building Relationships with Schools and School Districts
Both Dr. Wolraich and Dr. Wallace encourage clinicians to build relationships with schools and school districts. Simple strategies to get started include connecting with school psychologists or offering to serve as a resource, such as by providing presentations to staff on topics like ADHD.
If a school or school district has a designated parent advisor or advocate, this can be an especially valuable resource for families, as well as any community-based networks for children with mental health disorders or other disabilities.
Finally, each time a clinician supports a family through the process of securing school-based interventions or accommodations, they have an opportunity to connect with school staff and build relationships that will aid in supporting future patients from that school.
RESOURCES:
- For a variety of sample letters and templates, check out this article from Understood.org.
- Click here to learn more information about the Individuals with Disabilities Education Act (IDEA).
- Read about the 13 disability categories under IDEA here.
- For a menu of common ADHD accommodations, click here.
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