1. Guidance for Accommodating Children with Special Dietary Needs in the School Nutrition Programs Presented by: The NH Department of Education, Bureau of Nutrition Programs and Services Judy Gosselin Elaine VanDyke School Food Service Directors: Meagan Bizzarro, RD, LD; FSD Joyce Liebl, RD,LD; FSD Pat Laska, RD FSD Cheri White, MS Child Health Services Nutrition Feeding and Swallowing Program Honey Weiss, MS,RD,LD Judith Mikami, CCC,SLP

2. Rehabilitation Act of 1973 Prohibits discrimination against qualified persons with disabilities in the programs or activities of any agency of the federal governments executive branch or any organization receiving federal financial assistance.

3. Federal Laws that Guide the Child Nutrition Programs  IDEA-Requires a free and appropriate public education be provided for children with disabilities aged 3-21. IDEA=Individuals with Disabilities Education Act  ADA- Broadens and extends Civil Rights protections for approximately 50 million Americans with disabilities. ADA=Americans with Disabilities Act

4. USDA Law 7-CFR 15b & 210 USDA Non-discrimination and National School Lunch/Breakfast regulations  Clearly defines that substitutions to the regular meal MUST be made for children who are unable to eat school meals because of their disabilities, when that need is certified by a physician.  The information is documented by a licensed physician using the Special Meals Prescription Form.

5. Tools to Use for Implementing the Laws  The written document that contains the program of special education and related services to be provided to a child with a disability covered under IDEA. IEP- Individualized Education Program/Plan This is the correct tool for required nutrition services when the child also has an educational disability.  The written document that contains the services to be provided to a child with a disability. Section 504 Plan- a format for non-educational disabilities This is the correct tool for required nutrition services when there is a disability but no educational disability. School officials must ensure that school food service staff are involved at the incept of the nutrition services requirements

6. Special Meals Prescription Form  The Statement must identify: The child’s disability and an explanation of why the disability restricts the child’s diet. The major life activity affected by the disability. The food or foods to be omitted from the child’s diet. The food or choice of foods that must be substituted.

7. Food Allergies vs Disabilities  Children with food allergies or intolerances generally do not have a disability.  However, when a physician’s prescription indicates food allergies MAY RESULT in severe, life-threatening (anaphylactic) reactions, the condition is a“disability” and the substitutions prescribed by the physician must be made.

8. School Food Authority Responsibility  The SFA is responsible for ensuring that the benefits of the National School Lunch Program are made available to all children including children with disabilities.  A. What are the school food service responsibilities?  B. Where and how can funds be found and accessed?  C. Who can provide more information and technical assistance?

9. A. School Food Service Responsibilities  Staff must make food substitutions or accommodations for students with disabilities.  Substitutions for students with disabilities must be documented by the physician on the Special Meals Prescription Form.  Encouraged but not required to provide food substitutions or accommodations on a case by case basis for other children with medically certified special dietary needs.  Under no circumstances are school food service staff to revise or change a special Meals Prescription Form or medical order.

10. Providing Special Meals to Children with Disabilities  The SFA is required to offer special meals at no additional cost to children with defined disabilities.  A nutrition component in the IEP requires the involvement of the appropriate food service staff.  The school food service is not required to provide meal services to children with disabilities when the meal service is not normally available to the general student body, unless the food service is require under the IEP. (Such as; when no meals are served to Kindergarten students because they are not in the school during meal service, then Special Dietary Meals are not required; if school is closed for any reason and the general student body is not in attendance then no meals will be provided).

11. Menu Modifications  Children with disabilities who require changes to the basic meal are required to provide a Special Meals Prescription Form completed by a licensed physician. Special Meals should be reflected on the production record. School food service staff must follow the instructions that have been prescribed.

12. Serving Special Dietary Needs of Children without Disabilities  Children who have special health needs that require dietary modifications may request that a school food service meet their needs. Case by case consideration. A licensed physician must document the Diet orders. Schools are not required by law to make meal modifications due to personal opinions regarding “healthy” diets.

13. B. Funding Sources  Price of Meals: Meals must be served free or at a reduced price to all qualified children. Schools may not charge children with disabilities or with certified special dietary needs who require food substitutions or modifications more than they charge other children for program meals or snacks.

14. Additional Fund Resources  Most expenses should be able to be absorbed by Food Service for the cost of making meal modifications.  However, the cost may be so high that alternative sources of funding should be sought. These other funds may be: General Fund IDEA Funds Medicaid- Title XIX; Medicare Social Security Income Maternal and Child Health Services Block Grants Title V

15. Local & State Contacts LOCAL CONTACTS  The local school ADA coordinator  The school nurse  Occupational and physical therapists’  Local registered dietitian STATE CONTACTS Department of Education  Bureau of Nutrition Programs and Services 603-271-3646 Catastrophic Illness Program  603-271-4518 NH Dietetic Association  http://www.eatrightnh.orghttp://www.eatrightnh.org State DHHS Title V Director  Maternal and Child Health  Children with Special Health Care Needs Child and Family Service  Child Health Services Nutrition, Feeding and Swallowing Program 603-606-5456

16. Legal Concerns and Liability  What you may care to discuss! 1.The School Food Authority’s responsibility for providing program accommodations for children with disabilities. 2. Personal responsibility in cases of negligence.

17. Legal Citations  Individuals with Disabilities Education Act (IDEA).  Title II- equal and accessibility in state and local government programs and services.  Title III- extends accommodation requirements to privately owned facilities.  Title V- Section 504- Rehabilitation Act of 1973.  7 CFR- 15(b)3; 7 CFR 210.  FCS Instruction 783-2 Revision 2- Meal Substitutions for Medical or Other Special Dietary Reasons.

18. Personal Responsibility in cases of Negligence  School Food Authorities must ensure that both facilities and personnel are adequate to provide necessary services It may be advisable for specially trained personnel to provide guidance to the school nutrition staff. It may be necessary to have a nurse or health aide feed or assist the child.  Who will feed the child is a local decision Food Service is responsible for providing the necessary foods– however, it is not the specific responsibility of the food service staff to physically feed the child. Schools should note that they could be held liable if persons without sufficient training are performing tasks or activities prescribed by a licensed physician.

19. Questions and Resources  Resource List: http://www.education.nh.gov/program/nutrition/index.htm http://www.foodallergy.org Questions: Bureau of Nutrition Programs and Services 603-271-3646 Child Health Services- 603-606-5456