1. Management of Special Diets in Schools: A Team Approach Searcy School District Health Services & Child Nutrition Departments

2. Introduction of Team Members Charlotte Davis, RD, LD, SNS—District Child Nutrition Director Trey McMinn, RN, BSN—District Health Services Coordinator & School Nurse for McRae Elementary Suzanne Pitts, RN, BSN—School Nurse, Sidney Deener Elementary School Esther Huffman—School Child Nutrition Manager— McRae Elementary School Donna Franks—School Child Nutrition Manager— Sidney Deener Elementary School

3. Workshop Objectives Demonstrate knowledge of legislation and regulations affecting the need for special diet modifications in schools List multi-disciplinary challenges involved with the implementation of special diets Determine appropriate resources for assistance with the implementation and monitoring of special diets

4. Definition: Children with special health care needs are defined as those children “who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that required by children generally” Includes children who are chronically ill, medically fragile, or technology dependent.

5. Statistics Estimated 12.8% of children in the U.S. have a special health care need Reports indicate that up to 40% of these children have a nutrition-related problem

6. Legislation & Regulations Primary resource for this portion of the session was the book: Managing Child Nutrition Programs: Leadership for Excellence, 2 nd Edition, 2008 (NOTE: A copy of this book was provided to all district Child Nutrition Directors by the ADE/Child Nutrition Unit staff in August of 2008, so each district should have one)

7. Legislation & Regulations 1946 – National School Lunch Act 1966 – Child Nutrition Act 1975 – Public Law 94-142, “Education of All Handicapped Children Act” 1982 – Amendments to the Rehabilitation Act of 1973, Section 504 1982 – 7 CFR (Code of Federal Regulations), Part 15

8. Legislation & Regulations (Continued) 1986 – Public Law 99-457, “Individuals with Disabilities Education Act” (IDEA) 1990 – Americans with Disabilities Act 1994 – Public Law 103-448, “Healthy Meals for Healthy Americans Act of 1994” 1997 – IDEA, CFR Section 300.24 (b) (12) 2004 – IDEA, “Transition Requirements Between States” (more detailed explanation of these in resource, p. 449)

9. Legislation & Regulations (Continued) “So, what do we HAVE to do?” Strictly follow any physician-signed “Certification of Disability for Special Dietary Needs” form. Costs of any special foods for meals/snacks/supplements, preparation equipment, eating utensils, etc., may be covered with federal Child Nutrition Program funding.

10. Certification of Disability for Special Dietary Needs MUST Contain: The child’s disability and an explanation of why the disability restricts the diet The major life activity affected by the disability The food or foods to be omitted, as well as the food or choice of foods to be substituted (USDA, 2001)

11. What if NO Certification Form? No federal or state “requirement” to meet other requests for food restrictions (for lactose intolerance, religious preferences, etc.) District policy should be developed to address these situations.

12. Health Services Challenges Completion of Necessary Forms: - Student Health Information & “Emergency Contacts” forms, from parents - “Certification of Disability for Special Dietary Needs” forms (CD-SDN) from physicians Parent/Guardian Involvement: - Attendance at 504 meetings, etc. Child Nutrition Involvement - Good communication is a MUST

13. Suggestions Team Approach (Representatives from Health and Child Nutrition Services need to sit down together and discuss issues/problem resolution) Development of district policy to clear up confusion (see sample policy handout) assuring that timelines (e.g. one week limit to receive CD-SDN form), responsible parties, and funding issues are addressed (e.g. for non CD-SDN snacks) Development of district-specific forms/tools to assist with implementation (see sample forms)

14. Child Nutrition Challenges Ever-increasing NUMBER of students with special diet requirements, many very unique (e.g. PKU) Increased need for nutrient “information” for all foods served (e.g. carb-counting for diabetics) Identification/recognition of these students, especially at the beginning of a new school year and when “regular” staff not present Parent confusion and potential emotional situations regarding diet restrictions Student confusion or rebellion over diet restrictions

15. Child Nutrition Challenges (Continued) Potential lack of knowledge regarding special diets on the part of meal supervision faculty/staff How to keep track of substitutions made for special diets (for parent and “regulatory” documentation) Need for staff training (and re-training!) regarding special diet modifications including label reading for allergen information, etc.

16. Suggestions: Consider computer-analysis of district menus to provide organized/accurate carbohydrate-counting information for Health Services staff—if not, be sure to keep food labels, anyway (required by federal regulations for School Meal Initiative, 1996) Create “book” with student pictures with allergies, etc. listed Ensure that all Child Nutrition Program Managers and Staff are regularly TRAINED regarding compliance to special diets Work with Health Services and Administrators to determine how to handle “problems” when they arise

17. Q & A ANY QUESTIONS?