In most local school districts, the number of students with Individualized Education Plans, or IEPs, has risen over the past decades, outpacing a smaller upward trend statewide.
This school year, 17.4 percent of Massachusetts students have IEPs -- a personalized program for children determined to need special education services. The commonwealth's percentage is consistently among the highest in the nation, though still well below 2016-17 numbers at some local school districts where more than over a fifth of students have IEPs.
In Fitchburg 23.5 percent of students have IEPs, up from 18.1 percent 10 years ago. In Leominster the number is 22 percent, up from 17.4 percent in the 2006-07 school year. Ayer Shirley and North Middlesex school districts also came in just over the 20 percent mark this year.
The reasons for these increases are complex but relate to specifics of the student population, mental-health needs and differing district approaches, according to local officials and experts.
In some districts, like Leominster, the number of young students with mental-health needs has dramatically increased over the past roughly 15 years, according to Leominster Schools Special Education Director Ned Pratt.
"We're getting more and more kids younger and younger who have severe mental-health issues," he said. "I'm finishing my 35th year of education service. I've been a special ed director for over 20 years.
I've been an educational administrator for over 15. The acuity of needs, the level of sickness for so many of our younger kids in mental health is unbelievable."
Some students on IEPs require only an in-class tutor, others benefit from a separate classroom environment, and some need to be placed outside of the district in other schools or residential facilities, he said.
The wide range of personalized solutions created through IEPs are reflective of the spectrum of student needs, from severe disabilities to ADHD diagnoses to language and physical disabilities.
"The IEP is really a bridge to allow students to access the general curriculum," said Anne Howard, a professor of education at Fitchburg State University and board president of Boston nonprofit, Federation for Children with Special Needs.
According to Howard, the increase in student needs seen by Pratt is geographically widespread.
"You look at the number of kids with mental-health diagnoses, you look at the number of kids with autism diagnoses ... it's absolutely increased significantly," she said.
Pratt has seen the incidents of students in first grade and lower being carried away from school in an ambulance for a mental-health issue increase from "once in a while" to commonplace, he said.
"Now you see it all the time," he said.
Howard isn't sure whether these increased numbers are a result of raised awareness, though changes in the environment and, for children with severe disabilities, improving neonatal medicine, could be contributors.
Pratt pegs the shift to concrete changes in behavior, not just awareness, he said. The opioid crisis may be affecting these young children, he contends.
Two other factors have likely driven up the percentage of IEPs in Leominster, he said.
The first is homelessness. Of the 6,047 students in the Leominster District, 288 are homeless, which Pratt said is above average. About 60 percent of these students have IEPs, he said.
The second may be an unexpected by-product of the campaign led by Mayor Dean Mazzarella and his daughter, Stephanie Madrigal, to make Leominster an autism-friendly city, which Pratt said is a "great program."
The effort hit local and national papers, bringing people to the city and school district.
"We had an influx of students coming into our district moving from not just the communities around us," he said. "We had people from Tennessee. We had one family from Alaska who came to us specifically."
In Fitchburg, Director of Pupil Services Roann Demanche said more students with IEPs moved into the district, particularly in the past year.
"Our classrooms for students with emotional impairment are full," she said.
Long term, Fitchburg has seen more group homes that house children under the custody of the Department of Children & Families move into the area, she said.
Though not all children under the custody of the DCF have IEPs, it increases the probability she said.
While the guidelines for determining which students need IEPs and the options available are governed by federal law, how these guidelines are implemented from state to state and district to district vary, according to Howard.
"Massachusetts has had a history of really meeting the needs of students with disabilities in really a more extensive way than many states," she said.
For example, the state mandates a faster timeline to make a finding than required by nationwide laws. State guidelines also vary from the national for children with autism, according to the state Department of Elementary and Secondary Education.
Determining if a student needs an IEP is a multistep process, that consults teachers, district special education officials and parents or guardians, Pratt said. In some cases, lawyers or advocates representing the parent, school principals and even the student are also involved in the decision-making process following a testing and evaluation period.
If the student is found to need special education, the team of decision-makers must determine what plan is "appropriate" and creates the "least restrictive environment" for the student.
The goal is to address the student's needs while also keeping the student as involved in the school's general population as possible, Pratt said.
Though most decisions are made in the district without state intervention, the process follows specific nation and statewide guidelines, he said.
According to Howard, school funding, which varies widely from district to district, can have an impact on the programs available to students and how schools may use their resources.
"Some districts have a lot of supports to help that child (struggling in a subject)," she said. "Other districts don't and when that's the case, special ed is really the only game in town. So if you want a child to get more services you have to put them on an IEP."
But this can cut both ways, with wealthier districts sometimes having more students with IEPs, because of greater parent advocacy and greater resources, according to Felicia Farron-Davis, an associate professor of education at Fitchburg State University.
"All I can say is follow the money," she said.
In both Fitchburg and Leominster, Special Education made up 23.3 percent of the fiscal 2015 budget, according to the state Department of Elementary and Secondary Education. The state average was 21.1 percent.
In Leominster, the special education budget totaled $16.8 million. In Fitchburg, it was $13.4 million.
Students on IEPs cost districts more on a per-person basis than students in the general population, Pratt said. How much depends on what type of services the student is receiving.
Students placed in separate classrooms can cost the district an additional 30 percent annually whereas residential placement can cost as much as 20 times a single general education student.
Demanche said the district pays a half-million dollars each for a handful of students in the district because of soaring private school placement prices.
According to Pratt, state funding reimburses some of these costs, but "antiquated" funding equations mean the Leominster district still spends more on these students than those in the general population.
When district budget cuts come, such as proposed cuts in Leominster, these high costs could mean trouble, because IEPs are legal documents, according to Pratt.
"If we don't do as we promise we do with the parent signature on that, parents can sue us," he said. "They can sue us in many different forms."
For students with disabilities, special education is a resource, but not the only one, according to Demanche.
Schools can refer students to outside counseling services, such LUK or Community Health Link, according to Demanche. Behavorial Concepts Inc., which opened on Authority Drive last year, also provides services for children with autism.
Students' needs don't stop when they leave school, Howard said.
"Kids are only in school six hours a day, and they have needs 24 hours," she said.