L.J. Ex Rel. Hudson v. Pittsburg Unified School District ( 2016 )


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  •                  FOR PUBLICATION
    UNITED STATES COURT OF APPEALS
    FOR THE NINTH CIRCUIT
    L. J., a minor, by and through his         No. 14-16139
    Guardian ad Litem; NASHIRA
    HUDSON, an individual,                      D.C. No.
    Plaintiffs-Appellants,   3:13-cv-03854-JSC
    v.
    OPINION
    PITTSBURG UNIFIED SCHOOL
    DISTRICT; LINDA K. RONDEAU, in
    her official capacity as
    Superintendent of the Pittsburg
    Unified School District,
    Defendants-Appellees.
    Appeal from the United States District Court
    for the Northern District of California
    Jacqueline Scott Corley, Magistrate Judge, Presiding
    Argued and Submitted June 16, 2016
    San Francisco, California
    Filed September 1, 2016
    Before: Mary M. Schroeder, A. Wallace Tashima,
    and John B. Owens, Circuit Judges.
    Opinion by Judge Schroeder
    2                   L.J. V. PITTSBURG U.S.D.
    SUMMARY*
    Individuals with Disabilities Education Act
    The panel reversed the district court’s summary judgment
    in favor of the defendant school district in an action brought
    by a student and his mother under the Individuals with
    Disabilities Education Act.
    The panel held that the student was eligible for special
    education services. The panel agreed with the district court
    that the student had three disabling conditions. The panel
    disagreed, however, with the district court’s and the state
    administrative law judge’s ruling that the student did not
    need special education services because of his satisfactory
    performance in general education. Rather, the student
    exhibited a need for services because his improved
    performance was due to his receipt of special services,
    including mental health counseling and assistance from a one-
    on-one paraeducator, which were not services offered to
    general education students. In addition, the district court did
    not adequately take into account the student’s continued
    troubling behavior and academic issues. The panel held that
    the student’s psychiatric hospitalizations and suicide attempts
    were relevant to his eligibility for specialized instruction even
    though they occurred outside the school environment.
    The panel held that the school district also committed
    procedural violations of the IDEA by failing to disclose
    school records and failing to conduct a health assessment.
    *
    This summary constitutes no part of the opinion of the court. It has
    been prepared by court staff for the convenience of the reader.
    L.J. V. PITTSBURG U.S.D.                     3
    The panel reversed the district court’s decision and
    remanded for it to order that the school district provide the
    remedy of an individualized educational plan.
    COUNSEL
    Jean Adams (argued), Adams Esq. APC, Oakland, California,
    for Plaintiffs-Appellants.
    Kimberly Smith (argued) and Stephanie S. Baril, Tomsky,
    Fagen Friedman & Fulfrost, LLP, Los Angeles, California;
    and Jan E. Tomsky, Fagen Friedman & Fulfrost, LLP,
    Oakland, California, for Defendants-Appellees.
    OPINION
    SCHROEDER, Circuit Judge:
    INTRODUCTION
    This is an Individuals with Disabilities Education Act
    (“IDEA”) case of an emotionally troubled young child with
    suicidal tendencies beginning in the second grade, and with
    attention deficit hyperactivity disorder (“ADHD”)
    augmenting his disruptive behaviors. Congress created the
    IDEA to bring disabled students into the public education
    system by requiring states to adopt procedures to develop
    individualized plans for such students. Students with
    disabilities are entitled to special education services to ensure
    that they receive a “free and appropriate public education”
    (“FAPE”).
    4                  L.J. V. PITTSBURG U.S.D.
    The Pittsburg Unified School District (“School District”)
    determined that L.J. was not entitled to special education
    services because he was not disabled, and its determination
    was upheld on administrative review. L.J.’s mother filed this
    action in federal district court to require the School District to
    provide L.J. with an Individualized Education Plan (“IEP”) to
    provide specialized services to assist with what she contends
    are serious disabilities.
    The district court reviewed the record and found that L.J.
    was disabled under three categories defined by the IDEA. It
    nevertheless concluded that an IEP for specialized services
    was not necessary because of L.J.’s satisfactory performance
    in general education classes. The court discounted L.J.’s
    suicide attempts as not bearing on the need for educational
    services because they took place outside of school.
    The school records show, however, that beginning in the
    second grade and continuing into the third and fourth grades,
    when the parent invoked administrative remedies, the School
    District had already been providing L.J. with special services,
    including counseling, one-on-one assistance, and instructional
    accommodations. These services resulted in L.J.’s materially
    improved performance. The School District consistently
    refused, however, to provide him with an IEP that would
    ensure such services in the future as required by the IDEA.
    The record also reflects that the School District violated
    procedural protections of the IDEA by failing to provide the
    parents with education records bearing on L.J.’s disabilities
    and services that had been provided. We therefore reverse
    and remand for consideration of appropriate remedies.
    L.J. V. PITTSBURG U.S.D.                   5
    BACKGROUND
    This case presents a bright child’s disturbingly troubled
    history in the primary grades of two through five. L.J. was
    suspended from school multiple times for disruptive behavior
    that included kicking and hitting his teachers, throwing rocks,
    calling teachers and students names, and endangering and
    physically injuring classmates. L.J. has attempted to kill
    himself on at least three occasions and has manifested
    suicidal ideations prompting the School District’s mental
    health providers to conduct at least one emergency suicide
    evaluation. L.J. has been diagnosed with three serious
    disorders, including Bipolar Disorder, Oppositional Defiant
    Disorder (“ODD”), and ADHD. He has been prescribed a
    cocktail of serious medications for these conditions.
    For years, L.J.’s mother has repeatedly requested, to no
    avail, that the School District find L.J. eligible for special
    education. The School District has provided many services
    to L.J., but has never classified L.J. as eligible for special
    education under the IDEA. Without such eligibility, L.J. is
    not guaranteed the services his mother believes that he needs,
    such as one-on-one educational therapy, counseling services,
    and behavior intervention services. Instead, the School
    District has transferred him between at least three different
    schools.
    The history of L.J.’s difficulties began in second grade.
    During this year, L.J. demonstrated inappropriate behaviors
    at school, including anger, lack of self-control, and not
    following rules. After being verbally disciplined by his
    teacher for bullying other students, L.J. told her that he
    wanted to die and that life was too hard. School staff called
    L.J.’s mother, and mental health staff prepared an emergency
    6                 L.J. V. PITTSBURG U.S.D.
    suicide evaluation. The School District referred L.J. to
    Lincoln Child Center (“Lincoln”), the School District’s
    counseling center, where mental health providers assessed
    him. L.J. was diagnosed with ADHD, ODD, and Bipolar
    Disorder.
    L.J. began his third grade year at the same school, but
    exhibited negative behaviors which the teacher had difficulty
    controlling. The School District held a student study team
    (“SST”) meeting on September 7, 2011. The purpose of an
    SST is to develop interventions for students having trouble in
    school, either academically or behaviorally. In many schools,
    an SST is the first step in addressing a student’s needs before
    initiating the IEP process.
    After L.J.’s SST meeting, the School District’s behavior
    specialist created a behavioral support plan (“BSP”) to
    address his problematic behavior. Over the course of the
    school year, the behavior specialist revised the BSP multiple
    times, but L.J. continued to act inappropriately. As a result
    of the failed BSP, the School District proposed moving L.J.
    to a segregated trailer at a different school, but with no
    special education services, with six other African-American
    boys with extreme behavior problems.
    L.J.’s mother disputed the move, retained counsel, and
    entered mediation. The parties settled by agreeing to place
    L.J., temporarily, in a different school, in a general education
    class, conditioned on his having a one-to-one behavioral aide.
    The School District also agreed to evaluate L.J. for special
    education.
    At the new school, a paraeducator was assigned to work
    with L.J. one-on-one, and continued to work with him
    L.J. V. PITTSBURG U.S.D.                   7
    through his third grade year. A paraeducator is a specially
    trained staff member, assigned to work with special education
    students.      While L.J. progressed academically and
    behaviorally, he continued to have issues. In April 2012, L.J.
    wrapped a seatbelt around his neck, and saying he wanted to
    die, began rolling around uncontrollably trying to rub his face
    on the ground. L.J. was taken to the emergency room.
    Also, pursuant to the settlement agreement, Dr. Sherry
    Burke, a school psychologist, conducted psychoeducational
    and functional analysis assessments of L.J. to assist the IEP
    team in determining if he qualified for special education
    under the categories of other health impairment, or specific
    learning disability. See 
    34 C.F.R. §§ 300.8
    (c)(9), (10). Dr.
    Burke reviewed available school records, conducted various
    interviews of L.J.’s teachers, counselors, and family
    members, and administered a series of tests. She concluded
    that L.J. did not meet the eligibility criteria for special
    education.
    On May 29, 2012, L.J. again attempted to kill himself by
    sticking his finger in a light socket and putting items down
    his throat. He said that everyone hated him and he did not
    want to live. He was then confined to a psychiatric hospital,
    causing him to miss six school days.
    The next day, May 30, 2012, while L.J. was hospitalized,
    the IEP team held a meeting to review L.J.’s assessment
    results and to make a special education eligibility
    determination. An IEP team is composed of School District
    teachers, the parent and other experts familiar with the child.
    See 
    20 U.S.C. § 1414
    (d)(1)(B). Dr. Burke presented her
    findings to the IEP team, including her recommendation that
    L.J. did not meet eligibility requirements. The IEP team
    8                 L.J. V. PITTSBURG U.S.D.
    agreed with the psychologist that L.J. had no qualifying
    disabilities.
    The next month, on June 25, 2012, L.J.’s mother formally
    requested all of L.J.’s school records from the School District,
    including any records from Lincoln, where L.J. had received
    counseling and had been assessed. The School District
    claimed there were no Lincoln records that had not already
    been disclosed. L.J.’s mother submitted another request for
    L.J.’s records on June 28. The School District again failed to
    disclose any further records.
    L.J. was admitted for psychiatric hospitalization on July
    17 and again on July 26, when he was detained as a danger to
    himself or others for banging his head and making threats.
    Doctors placed L.J. on the psychotropic medications,
    Adderall, Seroquel, and Wellbutrin, to help stabilize his mood
    and sustain focus, and later Vistaril to treat his anxiety.
    On July 27, 2012, L.J.’s mother filed a request for a due
    process hearing with the California Office of Administrative
    Hearings (“OAH”). She claimed that the School District
    denied L.J. a FAPE by failing to make him eligible for special
    education and related services, and that the School District
    had failed to conduct assessments in areas of suspected
    disability, specifically other health impairment and emotional
    disturbance. L.J.’s mother also contended that the School
    District had failed to make requested records available.
    The parties again participated in mediation on August 23,
    2012. The parties agreed to place L.J. at yet another
    elementary school, pending the School District’s review of
    L.J.’s psychiatric hospitalization records and Dr. Burke’s
    updating her report. The School District generated a new
    L.J. V. PITTSBURG U.S.D.                   9
    Assessment Plan for IEP eligibility purposes. L.J.’s mother
    authorized the release of L.J.’s psychiatric records on the
    condition that a school nurse would conduct a health
    assessment and that L.J.’s original third grade teacher would
    be included in the eligibility process.
    For fourth grade, beginning in the fall of 2012, L.J. was
    in a classroom with a teacher experienced in special
    education.       L.J. was also provided with special
    accommodations, including freedom to leave the classroom
    at will. On September 25, 2012, L.J. was suspended for two
    days for throwing rocks and threatening to kill the school’s
    principal. The teacher’s one-on-one assistance and special
    accommodations continued throughout the school year, and,
    as a result, L.J.’s academic performance was satisfactory.
    After Dr. Burke updated her assessments, a second IEP
    team meeting was held on October 9, 2012, to reconsider
    L.J.’s eligibility for special education services under the
    category of emotional disturbance.           See 
    34 C.F.R. § 300.8
    (c)(4). The requested third grade teacher was not
    present at the meeting and L.J. had not been assessed by a
    nurse, in violation of both conditions insisted upon by L.J.’s
    mother in the agreement. The team again concluded that L.J.
    was not eligible for special education, the same conclusion
    reached at the first meeting the preceding May, despite
    repeated intervening hospitalizations, heavy medications,
    renewed suicide attempts, and individualized
    accommodations in school.
    On October 15, 2012, L.J. filed an amended complaint
    with the California OAH. L.J.’s mother again submitted
    formal requests for L.J.’s school records in October and
    November 2012, and in March 2013. The mental health
    10                L.J. V. PITTSBURG U.S.D.
    records kept by the School District, including Lincoln, were
    never disclosed.
    During that fourth grade year, L.J. was sent to the office
    multiple times for physically injuring classmates, disrupting
    class, and refusing to follow directives. School staff
    contacted L.J.’s mother to pick him up from school early on
    numerous occasions. The School District conducted another
    mental health assessment. He was again diagnosed with
    ADHD. In this assessment, the clinician concluded his
    ADHD symptoms caused clinically significant impairment in
    L.J.’s social and academic functioning, that L.J. relied
    extensively on medications, and further, that he evidenced
    functional impairments in the areas of family relations, school
    performance, and peer relations.
    The following year, in the fall of 2013, the School District
    nevertheless placed L.J. in a regular fifth grade classroom
    without accommodations or services. In November, L.J. was
    rushed to the emergency room by ambulance after attempting
    to hang himself with a lanyard. That year, L.J. physically
    injured children and at least one teacher. L.J. was suspended
    for “kicking and hitting” his science teacher, calling another
    teacher “stupid,” and brandishing a fake knife in the
    classroom. L.J. was also suspended again because he
    endangered a classmate by putting expandable pellets in the
    classmate’s water bottle without his knowledge.
    That spring, L.J.’s due process request made its way
    before an Administrative Law Judge (“ALJ”). The ALJ
    conducted a three-day hearing in April, and on May 23, 2013,
    the ALJ issued her decision, denying all of L.J.’s requests for
    relief. The ALJ found that L.J. had no disabilities that would
    qualify him for special education services, and even if he had
    L.J. V. PITTSBURG U.S.D.                   11
    qualifying disabilities, he had not demonstrated a need for
    special services because his academic performance was
    satisfactory when he was able to attend school.
    PROCEDURAL BACKGROUND
    L.J. timely appealed the ALJ’s ruling to the district court.
    L.J. contended that he was eligible for special education
    services and asked the district court to order the School
    District to provide an IEP. The parties filed cross-motions for
    summary judgment. The district court disagreed with the
    ALJ’s decision that L.J. had no disabling conditions. The
    district court ruled that L.J. met the qualifying criteria as a
    student with three disabilities: specific learning disability,
    other health impairment (due to his ADHD), and serious
    emotional disturbance (due to his ODD and bipolar disorder).
    The district court, nevertheless, granted the School
    District’s motion for summary judgment, ruling that L.J. did
    not need special education services because of his satisfactory
    performance in general education. The district court adopted
    the ALJ’s findings that L.J. was performing well
    behaviorally, socially, and academically between May and
    October 2012 with the help of services the court characterized
    as general education accommodations, not individualized
    special education services.
    This appeal followed.
    STANDARD OF REVIEW
    The district court’s findings of fact are reviewed for clear
    error, even when the district court based those findings on an
    administrative record, and conclusions of law are reviewed de
    12                L.J. V. PITTSBURG U.S.D.
    novo. J.G. v. Douglas Cty. Sch. Dist., 
    552 F.3d 786
    , 793 (9th
    Cir. 2008). This court gives “due weight” to ALJ special
    education decisions. J.W. v. Fresno Unified Sch. Dist.,
    
    626 F.3d 431
    , 440–41 (9th Cir. 2010). This standard is far
    less deferential than judicial review of other agency actions,
    but requires this court to refrain from substituting its own
    notions of educational policy for those of the school authority
    it reviews. Amanda J. v. Clark Cty. Sch. Dist., 
    267 F.3d 877
    ,
    887–88 (9th Cir. 2001).
    I. Statutory Background and Legal Framework
    Under the IDEA, 
    20 U.S.C. §§ 1400
    –1491, all states that
    receive federal education funding must establish policies and
    procedures to ensure that a “free appropriate public education
    is available to all children with disabilities.” 
    Id.
     at
    § 1412(a)(1)(A). The IDEA defines a FAPE as “special
    education” that is provided at public expense. Id. at
    § 1401(9). A child receives a FAPE, for purposes of the
    IDEA, if the program addresses the child’s unique needs,
    provides adequate support services so that the child can take
    advantage of educational opportunities, and is in accord with
    the IEP. Id. A state must comply both procedurally and
    substantively with the IDEA. Id. at § 1400 et seq.
    In determining whether a student has received a FAPE in
    compliance with the IDEA, the court conducts both a
    procedural and substantive inquiry. The court considers
    whether the school complied with the procedures set forth in
    the IDEA. Bd. of Educ. v. Rowley, 
    458 U.S. 176
    , 206–07
    (1982). The court also evaluates whether the IEP in this case,
    or lack thereof, was reasonably calculated to enable the child
    to receive educational benefits. 
    Id.
     Where a court identifies
    a procedural violation that denied a student a FAPE, the court
    L.J. V. PITTSBURG U.S.D.                    13
    need not address the second substantive prong of the inquiry.
    Doug C. v. Haw. Dep’t. of Educ., 
    720 F.3d 1038
    , 1043 (9th
    Cir. 2013).
    Not all procedural violations constitute a denial of a
    FAPE. R.B. v. Napa Valley Unified Sch. Dist., 
    496 F.3d 932
    ,
    938 (9th Cir. 2007). A child is denied a FAPE when
    procedural inadequacies result in the loss of an educational
    opportunity, or seriously infringe on the parents’ opportunity
    to participate in the IEP formulation process. Doug C.,
    720 F.3d at 1043. A procedural error is harmless if the
    student is substantively ineligible for IDEA benefits. R.B.,
    
    496 F.3d at 942
    .
    II. Eligibility for IDEA Benefits
    The initial issue in this case is whether L.J. was
    substantively eligible for IDEA benefits, since the ALJ held
    he was not. A child is substantively eligible for special
    education and related services if he is a “child with a
    disability,” which is statutorily defined, in relevant part, as a
    child with a serious emotional disturbance, other health
    impairment, or specific learning disability and who, by reason
    thereof, needs special education and related services.
    
    20 U.S.C. § 1401
    (3)(A). California Education Code similarly
    provides that a “student with exceptional needs” who is
    eligible under § 1401(3)(A) must have an impairment that
    “requires instruction and services which cannot be provided
    with modification of the regular school program.” 
    Cal. Educ. Code §§ 56026
    (a), (b).
    Even if a child has such a disability, he or she does not
    qualify for special education services if support provided
    through the regular school program is sufficient. 20 U.S.C.
    14                L.J. V. PITTSBURG U.S.D.
    § 1401(3)(A); 
    Cal. Educ. Code § 56026
    . “[S]pecial classes,
    separate schooling, or other removal of children with
    disabilities from the regular educational environment occurs
    only when the nature or severity of the disability of a child is
    such that education in regular classes with the use of
    supplementary aids and services cannot be achieved
    satisfactorily.” 
    20 U.S.C. § 1412
    (a)(5)(A).
    The parties on appeal no longer dispute that L.J. should
    have been categorized as a child with a disability under three
    categories set forth in the statute. First, L.J. has a “specific
    learning disability” because he has exhibited a severe
    discrepancy between his intellectual ability and his
    achievement. 
    34 C.F.R. § 300.8
    (c)(10). Second, L.J. has an
    “other health impairment” because his ADHD and mood
    disorders interfere with his ability to progress academically
    and socially. 
    34 C.F.R. § 300.8
    (c)(9). Lastly, L.J.’s mood
    disorders constitute a “serious emotional disturbance.” 
    34 C.F.R. § 300.8
    (c)(4).
    The critical issue in this appeal therefore is whether L.J.
    demonstrated a need for special education services. This case
    differs from most IDEA cases in that L.J. never received an
    IEP because the School District continually maintained he
    had no qualifying disabilities. The ALJ agreed that he had no
    qualifying disabilities. The district court held that the ALJ
    was incorrect in this regard and that L.J. had qualifying
    disabilities. The district court went on to conclude, however,
    that L.J. was performing satisfactorily without the need for
    special education services. We must therefore determine
    whether general education was appropriate or whether L.J.
    exhibited a need for special education services.
    L.J. V. PITTSBURG U.S.D.                   15
    The appropriateness of a student’s eligibility should be
    assessed in terms of its appropriateness at the time of the
    child’s evaluation and not from the perspective of a later time
    with the benefit of hindsight. Adams v. Oregon, 
    195 F.3d 1141
    , 1149 (9th Cir. 1999). When making this assessment of
    whether an eligibility determination is “appropriate” under
    the IDEA, this court looks to the time of the child’s
    evaluation by the School District. We employ what is termed
    the “snapshot” rule that instructs the court to judge the
    appropriateness of the determination on the basis of the
    information reasonably available to the parties at the time of
    the IEP meeting. 
    Id.
     “An IEP must take into account what
    was and was not, objectively reasonable when the snapshot
    was taken.” 
    Id.
     (citation omitted). We judge the eligibility
    decision on the basis of whether it took the relevant
    information into account, not on whether or not it worked. 
    Id.
    In this case, it is undisputed that the snapshot period was
    the period surrounding the two IEP meetings: on May 30,
    2012, in the third grade, and October 9, 2012, in the fourth
    grade. That was the critical period on which the School
    District based its eligibility decisions, and the district court
    correctly focused on L.J.’s eligibility for special education by
    looking to his behavior, academic progress, and social needs
    at that time. The district court was correct when it found that
    L.J. should have been categorized as a child with a disability
    within the meaning of the IDEA. L.J. had multiple
    disabilities, which manifested serious behavioral problems.
    The district court nonetheless concluded that L.J. was not
    eligible for special education because he was academically
    performing satisfactorily without receiving special education
    services and on the basis of the general education curriculum.
    This was clear error because L.J. was receiving special
    16                L.J. V. PITTSBURG U.S.D.
    services, including mental health counseling and assistance
    from a one-on-one paraeducator. These are not services
    offered to general education students.
    This distinction is important. General education is what
    is provided to non-disabled children in the classroom.
    Students in the general education setting do not receive
    specialized services. Special education, on the other hand, is
    “specially designed instruction” to meet the unique needs of
    a child with a disability. 
    34 C.F.R. § 300.39
    (a)(1).
    “Specially designed instruction” is defined under the IDEA
    regulations:
    Specially designed instruction means
    adapting, as appropriate to the needs of an
    eligible child under this part, the content,
    methodology, or delivery of instruction—
    (i) To address the unique needs of the
    child that result from the child’s disability;
    and
    (ii) To ensure access of the child to the
    general curriculum, so that the child can meet
    the educational standards within the
    jurisdiction of the public agency that apply to
    all children.
    
    34 C.F.R. § 300.39
    (b)(3) (emphasis added).
    The district court decided that L.J. did not need an IEP
    because, despite his multiple disabilities, L.J. was performing
    satisfactorily in general education. The problem with the
    district court’s analysis is that many of the services the
    L.J. V. PITTSBURG U.S.D.                   17
    district court viewed as general education services were in
    fact special education services tailored to L.J.’s situation.
    The district court thus classified many of the services L.J.
    received as general education, when they were not.
    Discussion of a few examples will make the point.
    First, general education instruction does not provide for
    one-on-one direction. L.J. received special assistance in the
    third grade from a one-on-one paraeducator, pursuant to the
    parties agreement that year. The School District claims that
    the paraeducator “faded back considerably” by May 30, the
    date of the initial IEP meeting, but this is not accurate. The
    paraeducator continued to assist L.J. throughout the third
    grade.
    Second, general education instruction does not provide for
    specially designed mental health services. The School
    District’s position is that L.J. received only general education
    mental health services from Lincoln that the School District
    makes available to all students. The School District
    distinguishes such services from services received by special
    education students, which are specially designed mental
    health services.
    The flaw in the School District’s argument is that the
    mental health services that L.J. received from second grade
    through fourth grade were specially-designed for him. Such
    services included services that the School District described
    as follows: Assessments, Plan Development, Group and
    Individual Rehabilitation, Group and Individual Therapy,
    Family Therapy, and Collateral Family Group and Intensive
    Home-Based Services. The School District acknowledges
    that only students requiring special education receive an
    educationally-related mental health assessment. L.J. received
    18                L.J. V. PITTSBURG U.S.D.
    two such mental health assessments. L.J. was referred to
    Lincoln by the School District’s Director of Special
    Education and Psychological Services, and the School
    District acknowledged this means of referral is for special
    education students only.
    Third, general education instruction does not typically
    include extensive clinical interventions by a School District
    behavior specialist. While it is not unusual for a behavior
    specialist to offer support to a general education teacher, here
    the School District’s behavior specialist did much more.
    Throughout the third grade year, he designed specific BSPs
    in an attempt to meet L.J.’s needs. The plans included
    adapting the method and delivery of L.J.’s instruction, and
    strategies to promote a structured environment and reinforce
    positive behavior. The behavior specialist also designed a
    nine-hour training session for L.J.’s paraeducator. After
    training L.J.’s aide, the behavior specialist closely supervised
    him to ensure the interventions followed the new BSP.
    Fourth, general education instruction does not provide
    accommodations, such as persistent teacher oversight,
    additional time to complete classwork or tests, shortened
    assignments, discretion to leave the classroom at will, or the
    option to complete classwork or tests in other rooms or with
    one-on-one support. Nor does it always provide a teacher
    with special education experience like L.J.’s fourth grade
    teacher.
    The district court clearly erred by mischaracterizing all of
    these individualized accommodations and services as general
    education available to all students, rather than as special
    education provided to students with disabilities. The court
    went on to conclude, erroneously, that L.J. did not require
    L.J. V. PITTSBURG U.S.D.                  19
    specialized assistance in the future on the ground that he was
    no longer exhibiting behaviors that interfered with his school
    performance. Granted, his condition had improved during the
    snapshot period, for by the time of the IEP meetings, L.J.’s
    impairments had been eased with the accommodations and
    services provided by the School District. With the assistance
    of medication and specially designed instruction, L.J. had
    periods of temporary behavioral and academic gain. L.J.’s
    teachers, service providers, and mother all reported that L.J.
    had made good progress in academics and improved his
    social skills with his classmates during the snapshot period.
    Dr. Burke opined that his average or above-average
    academic testing scores showed academic achievement had
    not been impacted by any of his issues. Standardized tests
    ranked L.J.’s academic performance in an overall average
    range. Although there was progress, it was no doubt in a
    setting where multiple services were being provided and the
    progress must at least, in substantial part, be attributed to
    those services. Moreover, L.J. has shown himself to be an
    intelligent child, so his academic performance could have
    been even more improved with the appropriate specially
    designed instruction.
    Yet, L.J. continued to have troubling behavioral and
    academic issues during the snapshot period. The district
    court did not adequately take these into account when it
    decided there was no need for future specialized services.
    The information available to the IEP team during the
    snapshot period was dramatic.
    L.J. threatened and attempted to kill himself on numerous
    occasions. On May 29, 2012, the day before his initial IEP
    meeting, L.J. attempted to kill himself by sticking his finger
    20                L.J. V. PITTSBURG U.S.D.
    in a light socket and putting items down his throat. On May
    30, 2012, the day of his first eligibility determination, L.J.
    could not have been doing well socially, behaviorally, or
    academically at school because he was in extended care at a
    psychiatric hospital. He was confined to the hospital for over
    a week and missed at least six school days. L.J. was again
    admitted for psychiatric hospitalization on July 17 and July
    26, 2012. L.J. was detained as a danger to himself or others
    because he was banging his head against walls and making
    threats of harm.
    The district court concluded that L.J.’s psychiatric
    hospitalizations and suicide attempts were not relevant to his
    eligibility for specialized instruction because they occurred
    outside the school environment. Yet, the issue is whether his
    disabilities interfered with his education and necessitated
    special services. It is hard to imagine how an emotional
    disturbance so severe that it resulted in repeated suicide
    attempts would not interfere with school performance. That
    he attempted suicide outside the school environment is
    immaterial. His emotional disturbance adversely affected his
    attendance and his teachers all reported that L.J.’s classroom
    absences, due to psychiatric hospitalizations, hurt his
    academic performance. To distinguish between where a
    student attempted suicide—between home and
    school—misses the point. The point being that whether
    having a suicidal ideation and attempting suicide interfered
    with L.J.’s education.
    In fourth grade, in September, L.J. was suspended for two
    days after throwing rocks at and threatening to kill the school
    principal. The district court did not think his suspension was
    of great import, noting that it was only for two days. But this
    was not L.J.’s only incident. Shortly before the October 9,
    L.J. V. PITTSBURG U.S.D.                   21
    2012, IEP meeting, L.J. was unable to ride the school bus
    because he refused to follow the bus driver’s directions.
    L.J. also continually had needs associated with his
    medication and treatment for his mood disorders and ADHD.
    By fourth grade, L.J. relied on psychotropic medications in
    order to attend school. His fourth grade teacher reported that
    L.J.’s functioning declined in the absence of medication or
    when it had no mitigating effects. School counselors
    repeatedly expressed their concern regarding L.J.’s
    medication management. The district court neglected to
    discuss L.J.’s ongoing needs associated with his medication.
    L.J. clearly exhibited behavioral and academic difficulty
    during the snapshot period. He threatened and attempted to
    kill himself on three occasions in 2012. In the fall, he
    frequently acted out at school, and continued to have needs
    associated with his medication regimen. The district court
    should not have discounted these facts. They demonstrate
    that L.J. required special education services.
    Because L.J. is eligible for special education, the School
    District must formulate an IEP. We reverse the district
    court’s decision and remand for it to order that the School
    District provide that remedy.
    III.   Procedural Violations of the IDEA
    Procedural safeguards are built into the IDEA to ensure
    that a child’s education is fair and appropriate and the parents
    have an opportunity to participate in the IEP formulation
    process. Doug C., 720 F.3d at 1043. The record in this case
    reflects some serious violations of these safeguards by the
    School District.
    22               L.J. V. PITTSBURG U.S.D.
    The School District failed to disclose assessments,
    treatment plans, and progress notes from L.J.’s time at
    Lincoln. The district court erred in concluding that this
    failure did not interfere with L.J.’s mother’s opportunity to
    participate in the IEP formulation process.
    Under the IDEA, parents have the right to informed
    consent. 
    20 U.S.C. § 1414
    (a)(1)(D). Consent means that the
    parent has been fully informed of all information relevant to
    the activity for which consent is sought. 
    34 C.F.R. § 300.9
    (a). To guarantee parents the ability to make informed
    decisions about their child’s education, the IDEA gives them
    the right to examine all pertinent education records relating
    to their child. 
    20 U.S.C. § 1415
    (b)(1). The Lincoln records
    constitute such education records and should have been
    disclosed to L.J.’s mother.
    Parents also have the right to invite to attend IEP
    meetings individuals with knowledge or special expertise
    regarding their child. 
    34 C.F.R. § 300.321
    (a)(6). L.J.’s
    mother had the right to have L.J.’s mental health providers at
    both the May and October IEP meetings. 
    Id.
     Without
    knowledge of the Lincoln records, however, L.J.’s mother
    waived the attendance of his mental health clinicians at the
    IEP meetings. At the very least, L.J.’s parent should have
    received complete copies of the Lincoln records so that she
    could provide informed consent regarding the exclusion of his
    mental health providers from the IEP team. Had L.J.’s
    mother been aware of the content of the Lincoln records, she
    may well not have waived the mental health providers’
    attendance.
    The School District also failed to conduct a health
    assessment for the purpose of determining how L.J.’s health,
    L.J. V. PITTSBURG U.S.D.                    23
    and particularly his medications, affected his performance.
    The district court held that this error did not infringe on L.J.’s
    mother’s ability to participate in the IEP process because
    L.J.’s medications were not administered at school. We fail
    to see that the need for a health assessment should depend on
    where medications are administered, and we are cited to
    nothing in support of the proposition.
    Under the IDEA, the School District must conduct a “full
    and initial evaluation,” one which ensures the child is
    assessed in “all areas of suspected disability.” 
    20 U.S.C. §§ 1414
    (a)(1)(A), (b)(3)(B). This requirement allows the
    child’s IEP team to have a complete picture of the child’s
    functional, developmental, and academic needs. When a
    student has been diagnosed as having a chronic illness, as L.J.
    was, the student may be referred to the School District for a
    health assessment. 5 Cal. Code Reg. § 3021.1. A health
    assessment focuses on diagnoses, health history, and those
    specific health needs while in school which are necessary to
    assist a child with a disability. The regulations then require
    that the IEP team review, among other things, the “possible
    medical side effects and complications of treatment that could
    affect school functioning.” Id. The district court erred when
    it dismissed the School District’s failure to conduct a health
    assessment, depriving L.J. of an educational benefit. See
    Doug C., 720 F.3d at 1043 (a FAPE is denied where
    procedural inadequacies result in loss of educational
    benefits).
    Here, there is reason to believe that alternative services
    would have at least been more seriously considered during
    the IEP process if the School District had assessed L.J.’s
    health, including the effects of his medication on his health.
    The record evidence showed that L.J. continually had needs
    24                L.J. V. PITTSBURG U.S.D.
    associated with his medication and treatment, which
    adversely impacted his academic, behavioral, and social
    performance. Because his health and the impacts of his
    medication were never assessed, no matter what assistance
    L.J. received, the School District would remain unable to
    appropriately address those needs.
    In sum, the School District clearly violated important
    procedural safeguards set forth in the IDEA. The School
    District failed to disclose assessments, treatment plans, and
    progress notes kept by Lincoln, which deprived L.J.’s mother
    of her right to informed consent. The School District also
    failed to conduct a health assessment, which rendered the
    School District and IEP team unable to evaluate and address
    L.J.’s medication and treatment related needs.
    When this matter returns to the School District for the
    preparation of an IEP, the School District must comply with
    the IDEA’s procedural safeguards. Additional procedural
    violations can only result in the further protraction of
    proceedings and costly financial and emotional burdens for
    all those involved.
    CONCLUSION
    L.J. is a child with disabilities within the meaning of the
    IDEA and needs special education. The judgment of the
    district court is reversed and the matter remanded to the
    district court with instruction to order the School District to
    provide an appropriate remedy.
    Costs are awarded to Plaintiffs-Appellants.
    REVERSED and REMANDED.