Diabetes Care Tasks at School: What Key Personnel Need To Know LEGAL CONSIDERATIONS Diabetes Care Tasks at School: What Key Personnel Need To Know LEGAL CONSIDERATIONS The American Diabetes Association’s Diabetes Care Tasks at School: What Key Personnel Need to Know is a training curriculum that consists of PowerPoint modules with corresponding video segments, pre-/post-tests and other helpful resources. This training is based on and should be used in conjunction with the 2016 “Helping the Student with Diabetes Succeed: A Guide for School Personnel”, a guide developed by the National Diabetes Education Program (NDEP), which is a federally sponsored partnership of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention and over 200 partner organizations. Training participants should read the NDEP guide prior to this training in order to gain a full understanding of the requirements of appropriate school diabetes care. Participants should have a copy of the guide during this training and for future reference. The guide can be found on the web at http://www.ndep.nih.gov. Some key points about the overall training: Overall objective: The overall goal is to optimize both health and learning for students with diabetes by providing diabetes care training to school personnel about how and when to perform routine and emergency diabetes care tasks for students, under the supervision of a school nurse or another qualified health care professional. Completion of training will help prepare school personnel to perform diabetes care tasks, ensuring that health needs are addressed in times and locations when a nurse is not available. Rationale: The school nurse, when available, is the most appropriate person in the school setting to provide care for a student with diabetes. However, many schools do not have full- time nurses. Even for schools that do, the nurse may not always be available during the school day, during school-sponsored extra-curricular activities or field trips to assist with routine care and emergency care. Trained school personnel must be available to perform and assist the student with diabetes care tasks. August 2018 May 2018

Goal: Optimal Student Health and Learning Protecting students’ legal rights is a vital piece of a comprehensive plan. This This training component was created specifically for school nurses and other qualified health care professionals to train non-medical school personnel. These components are: • Diabetes Basics • Diabetes Medical Management Plan • Hypoglycemia • Hyperglycemia • Blood Glucose Monitoring • Continuous Glucose Monitoring • Glucagon Administration • Insulin Basics • Insulin by Syringe and Vial • Insulin by Pen • Insulin by Pump • Ketones • Nutrition and Physical Activity • After-School Programs, Sports and Camps • Before- and After- School Care • Childcare • Psychosocial Aspects • Legal Considerations This unit is Legal Considerations.

Participants will be able to understand: Learning Objectives Participants will be able to understand: Federal laws that protect students with diabetes Impact of state laws upon diabetes care in the school setting Recommendations for 504 Plans and IEPs This unit will be on laws that impact diabetes care in the school setting and will include: Federal laws that protect students with diabetes Impact of state laws upon diabetes care in the school setting Recommendations for 504 Plans and IEPs

Needs of Children With Diabetes in School Setting... A medically safe environment for students with diabetes Equal access to educational and school-sponsored opportunities Safe and supported transition to independent diabetes self- management Needs of children with diabetes in school setting: Students with diabetes need a medically safe environment. Students with diabetes must have the same access to educational and school-sponsored opportunities as do students without diabetes. Safe and supported transition to independent diabetes self-management.

Federal Laws: Equal Access Section 504 - Section 504 of the Rehabilitation Act of 1973 ADA - Americans with Disabilities Act IDEA - Individuals with Disabilities Education Act Three Federal laws address the school’s responsibilities to ensure access for students with disabilities: Section 504 of the Rehabilitation Act of 1973 (Section 504) Americans with Disabilities Act (ADA) Individuals with Disabilities Education Act (IDEA) The purpose of this training is not to fully describe these laws, but rather to talk generally about how they might impact care provided for a student with diabetes.

Students must be given equal opportunity Federal Protections Prohibits discrimination against people with disabilities by public schools and most private schools Students must be given equal opportunity Related aids and services are required to meet the individual needs of a student with a disability This slide provides an overview of the framework for planning and implementing accommodations for students with disabilities under 504, Americans with Disabilities Act and IDEA. One or more of these laws applies to all schools, except a private religious school that doesn’t receive any federal funding. These laws provide for: Related aids and services designed to meet the individual needs of the student Free, appropriate public education (FAPE) Equal opportunity Section 504 and ADA prohibit discrimination against children with disabilities by schools and/or day care centers. IDEA also requires special education for students whose diabetes or other disability adversely affects education performance (for example, this might be the case for a student who often experiences high and low blood glucose levels at school or who has to miss a lot of school because of diabetes related complications).

Written Plans Diabetes Medical Management Plan (DMMP) Individualized Health Care Plan (IHP) 504 Plan Individualized Education Program (IEP) Emergency Care Plan for Hypoglycemia Emergency Care Plan for Hyperglycemia It is important to make sure that the school personnel, parents/guardians, and the student agree on how the Diabetes Medical Management Plan (DMMP) will be implemented and what accommodations and related aids and services may be needed for the student. This information is included in a Section 504 Plan, Individualized Education Program (IEP), or other education plan. The information in the DMMP can be used in developing either a Section 504 plan or an IEP, but is not a substitute for a Section 504 Plan or IEP. The Individualized Health Care Plan (IHP) is developed by the school nurse to implement the DMMP. The IHP communicates the nursing management strategies for the student in the school setting. A “504 Plan” is the term commonly used for the written plan developed under Section 504 of the Rehabilitation Act. An Individualized Education Program (IEP) is required for students who receive special education and related services under the Individuals with Disabilities Education Act (IDEA). The Emergency Care Plans are quick references developed by the school nurse that describes the individual student’s symptoms and treatment of hypoglycemia and hyperglycemia.

Needs Addressed by 504 Plan/IEP Location and timing of blood glucose monitoring and insulin administration Identity of trained diabetes personnel Location of diabetes supplies Free access to water and restroom Nutritional needs, meals and snacks Full participation in all school-sponsored activities Access to blood glucose checks and treatment supplies during exams Alternative times for academic exams if student is experiencing hypoglycemia or hyperglycemia Absences without penalty for doctors’ appointments and diabetes-related illness Maintenance of confidentiality and student’s right to privacy The 504 or IEP plan should address accommodations needed for both routine and non-routine school activities and settings, even for relatively infrequent events, like standardized testing or overnight field trips. Listed on the slide are examples of the types of things that might be addressed. Anticipating such events and proactively addressing them when the plan is written will not only ensure the student’s safety and full participation, but also help to avoid misunderstanding and potential conflict between the school, parent/guardian, and/or health care providers. A sample 504 plan can be accessed on the American Diabetes Association Website at: http://www.diabetes.org/advocacy-and-legalresources/discrimination/school/504plan.jsp

State Laws & Regulations State and local laws and regulations vary regarding who may perform various aspects of diabetes care Become familiar with state and local laws that impact school diabetes care Regardless of state and local law, the requirements of federal laws must be met For your state’s laws go to www.diabetes.org/kidswin State and local laws and regulations vary regarding who may perform various aspects of diabetes care. Some states allow non-medical school staff members to provide routine and emergency diabetes care. Some state have laws that require a minimum number of school staff members be trained and available on site to provide diabetes care. Some states limit the ability of non-medical personnel to provide care. Become familiar with state and local laws that specifically address school diabetes care. Regardless of state and local law, the requirements of federal laws must be met. Thus, diabetes care cannot be denied based on state or local laws or policies that seek to limit who can provide care. For more information about your state’s laws go to www.diabetes.org/kidswin

Module 17 Pre – and Post – Tests: LEGAL CONSIDERATIONS This tool may be freely duplicated and distributed for training purposes

Which of the laws below does not provide protection children with diabetes in the school setting? Section 504 Affordable Care Act Americans with Disabilities Act Individuals with Disabilities Education Act Which of the following is a reasonable accommodation for a student with diabetes? Send student to a school with other students with diabetes in order to receive care Require another student to walk student to the clinic when experiencing hypoglycemia Require a self-managing student going to clinic to do blood glucose monitoring Providing a school nurse or other trained school staff member to accompany student on a field trip Regardless of state law, the requirements of federal laws must be met. True False

American Diabetes Association Where to Get More Information American Diabetes Association 1-800- DIABETES www.diabetes.org/safeatschool