Last week, on the evening of November 5, our recently opened Washington Nationals Diabetes Care Complex hosted Crystal Jackson and her American Diabetes Association Safe at School Team for a discussion of "Strategies for Keeping Children with Diabetes Safe at School.” As everyone is aware, our children spend the majority of the daily life at school or school related extracurricular activities. As such, the meticulous diabetes care provided at home should be available to our children at school. Unfortunately, this is not always the case and intervention from the diabetes healthcare team and if necessary advocacy from the American Diabetes Association is sometimes required.
Crystal's presentation was excellent. I will briefly summarize the main points to educate and inform all of our parents with children in the school setting. This material is available on line at the ADA website: www.diabetes.org/safeatschool.
1. Schools must provide a medically safe environment for students with diabetes.
2. As such, students with diabetes "must have the same access" to educational and extra-curricular activities as their peers related to school activities.
3. Therefore, schools must work with the parent and student to support transition to independence.
The American Diabetes Association supports having a full time nurse at school. However, as is painfully clear, most schools do not have a full time nurse, let alone a nurse that is present at the school every day! The ADA as well as the Children's National Diabetes program supports training school personnel in the absence of a school nurse. In 2012, with support from the Washington DC's department of public health, our diabetes team provided 2 sessions to help train District public schools non-healthcare personnel. Therefore, all school staff members should have information about diabetes and be provided with contacts if in need of assistance.
According to Jackson and the ADA, students should be permitted to provide self-care whenever they are at school or school-related activities.
And so, IF there is:
1. failure to have trained staff to assist students with diabetes,
2. school refusal to administer insulin,
3. school refusal to administer glucagon,
4. no coverage during field trips and extracurricular activities,
5. school refusal to permit blood glucose checks outside of the health room or office,
6. sending the child to diabetes school, OR
7. school refusal to allow a student to actually attend the school,
Then discrimination has occurred. Discrimination occurs when children to do not get the care that is necessary OR get the care they need by either missing school-related activities or requiring that a family member be present at the activity. According to Jackson, the bottom line is: if learning or health is compromised,: legal rights are compromised!
There are both state and federal laws that apply to our children with diabetes. The Federal laws include:
1. Americans with Disabilities Act (ADA)
2. Section 504 of the Rehabilitation Act of 1973
3. Individuals with Disabilities in Education Act (IDEA)
The State laws, regulations and guidelines "prohibit discrimination on the basis of disability, retaliation for asserting the right not to be discriminated against and is NOT limited to disabilities that affect learning and academic progress." However, state and local laws and regulations vary regarding who may perform various functions of diabetes care (i.e., controversy in California Board of Nursing,which was overturned!).
The ADA and Section 504 protections include:
- a physical/mental impairment that limits one or more of major life activities (diabetes)
- a record of such an impairment (diabetes)
- being regarded as having an impairment (diabetes)
What schools are covered by the ADA and Section 504?
Public, private and day care centers
What schools are NOT covered by the ADA and Section 504?
Religious institutions (UNLESS they receive federal funds).
Therefore, the law requires that discrimination is avoided, and that schools must make "reasonable changes in practices and policies to afford equal opportunities."
It is important that the child's caregiver must provide the school with certain materials including a note from the child's diabetes healthcare provider noting that your child has a "disability" because he/she is limited in endocrine function. The caregiver should also add that major life activities are adversely affected if your child is experiencing highs or lows.
Caregivers should develop a Diabetes Management plan that is the basis for a Section 504 plan that should be updated accordingly in order to accommodate school testing, standardized testing (PSAT, SAT, etc). There are accommodations that are provided that include "frequent breaks, longer breaks, access to food/supplies/ or snacks."
In summary, according to Crystal Jackson and the ADA (as well as our own Diabetes team at Children’s National) the key to successful life for your child with diabetes in school, includes "EDUCATION, NEGOTIATION, LITIGATION (necessary) and LEGISLATION (if all else fails).
We appreciate Crystal Jackson and the ADA team for supporting and advocating for our children with diabetes. For further information, please visit the ADA website where there are samples of the Diabetes Management and Section 504 plans.
Published On: November 20, 2013