Dear Dr. Wes:
I heard you on Up to Date with Steve Kraske talking about IEPs, 504s, and student improvement plans and medication management with psychotherapy. The school told us that if my child didn’t take medication, he’d be kicked out of elementary school. Can they do that?
The short answer is “no.”
No school district I’m familiar with has on staff a physician or nurse practitioner who is able to prescribe medication and even if they did, a prescriber cannot order a client to take medication against the will of the client or the parent. Only a court might have that power and only in extreme circumstances in which the child’s best interest clearly outweighed his/her own will and that of the parent. When we’ve had courts order medication for a minor, our office has refused if the client refused. Case closed.
I’ve heard this complaint repeated numerous times, seen it published in books and newspaper articles, and yet I’ve never sat in a meeting or read a document or spoken to a teacher, principal, or special education instructor who can verify that it happened. I’m not saying it didn’t in your case, because I wasn’t in on the discussions in your child’s school, but I am saying that making a recommendation like that would bring significant consequences for the school. When it comes in the form of a demand, those consequences rise to the level of potential civil litigation.
The long answer is more complicated than that, however. First, let’s think through how the federal law (IDEA) guiding special education and accommodation in schools would look upon such a demand. You’re proposing that a public school is requiring as a condition of attendance that your child take medication. If your situation is like most I’ve been consulted on, we can presume the child’s behavior is allegedly so severe that the school cannot contain the child in the regular classroom and still guarantee the education or safety of the other students. The story usually goes in one of two directions at this point.
- A physician has recommended a medication for the child and the child or parent has been noncompliant. The school has become aware of this either because the medication has been given at school and now is not being given or the parent has otherwise mentioned this in a school meeting. If the school feels the medication is not being given as prescribed, it has no power to require compliance. What it can do is require the child be remanded to a specialized classroom for disruptive children. That can be done either through a behavioral referral for discipline or by recommending the child be assessed for an Individualized Educational Plan (IEP). The parent can then decide if having the child in a classroom for emotionally disturbed or behaviorally disruptive children is preferable to taking the medication. Some parents feel this is coercive; that they are being forced to put their child on medication. Schools see it as the only alternative to deal with a disruptive student. But yes, that conflict can happen.
- The school states to the parent that the child must be on medication to continue attending school and request a medication referral. The problem with this scenario is that by making medication a condition of attendance, the school is essentially offering to write the check for the evaluation and treatment. This is because if a school believes a child needs a specific and reasonable accommodation (in this case medication) to learn, the school is obligated to provide that accommodation under Section 504 of IDEA. If that’s a wheelchair ramp for a chair-bound student, the school has to cover the cost. Most schools know this, and since they don’t want to get into the business of paying for mental health services, most schools do not make these demands. Could there be exceptions? Perhaps. But it would be implausible. When I was in teacher training I took a course on this topic, as did my wife, and both instructors admonished us never to make any hint of a suggestion that a child needed anything, lest the school end up paying for it. While I’ve found that position a bit fanciful, your scenario would absolutely invoke the point the instructors were making.
In either scenario, the parent cannot be compelled to use medication. However, if without medication the child cannot function in the classroom, the school can eject and even expel the child as a disciplinary problem or safety concern. Or if the school acknowledges the presence of a mental illness, the school could recommend alternative education up to and including homebound education.
Theoretically, the school could also file a complaint with child protective services, though that would be an extreme decision. The complaint would allege emotional or medical neglect, a very difficult charge to prove, especially in the scenario you describe.
Consistent with what I said on Up to Date, medication for anxiety, depression, and ADHD can be figuratively and even literally lifesaving. However, that usually happens only when parents, kids, therapists, prescribers, and hopefully, school personnel all work as a team. When that happens, I’ve seen amazing things happen. When any one member of that team is off on his or her own page of music, I’ve seen things go as poorly as you can imagine. That’s why we have tremendous outcomes with integrative treatment using medication and therapy. No, we’re not always successful, but with a united front things usually come out better.
What to Do?
If you feel coerced by the school into using treatments you’re uncomfortable with, ask that they put this recommendation in writing. It’s difficult to imagine, but if they do, then you have a clear piece of evidence. And if they don’t, they can’t enforce the demand. If your child is already on an IEP and you disagree with the recommendation, read your rights and responsibilities pamphlet handed out at every IEP meeting. In it you’ll find the procedure for due process. If your child is not on an IEP and the school is making this demand, give written notice that you want the child to be assessed for services. They have to do the evaluation is sixty school days (not including summer and breaks). They school may well try to refuse, but if they are demanding medication they really have no grounds upon which to do so.
Consult with a psychologist or other mental health professional about your child’s behavior and mental health status. Pay that person to observe your child for two or three hours in the classroom before your child knows he is being observed. The school may be seeing issues you’re not. While that doesn’t justify recommending medication as a requirement of attendance, our office has seen cases in which parents are the ones “not on the team.” That might not be the situation in your case, but I always recommend to my clients that they look first at themselves and their child and then at the school. Sometimes we don’t want to see our child as the responsible party and in avoiding that awareness we enable more bad conduct.
Don’t be that parent. You won’t like the outcome.