Outside the School Lunch Box: Accommodating Students with Special Dietary Needs

1. Outside the School Lunch Box:Accommodating Students with Special Dietary Needs

2. Special Education Services Food and Nutritionas Supplementary or Related ServicesJuly 13, 2010 Diane Hawkins

3. Special Education Eligibility: 1.Presence of an identified disability AND 2.Educational need for specialized programming as a result of said disability.

4. IDEA/IDEIA • Federal funding source for eligible students enrolled in Special Education Programs in public school settings • Eligible students demonstrate a need for specialized programming due to a recognized specific disability

5. Decisions, Decisions, Decisions Admissions, Review, Dismissal Committee THE ARD

6. The Plan The Individual Educational Plan The IEP

7. Individual Educational Plan • Establishes eligibility • Reviews present levels of academic and functional performance • Establishes instructional goals and objectives • Determines placement and programming

8. 504 • Federal law intended to protect the rights of individuals with disabilities in programs and activities that receive federal financial assistance • Eligible students demonstrate, have a record of demonstrating, or are regarded as demonstrating a physical or mental impairment that substantially limits one or more major life activities

9. 504 Broad Disability Categories Applies to schools, agencies and other institutions that receive federal funds Un-funded mandate IDEA/IDEIA Specific Disability Applies to Public Schools Funded via Federal and State sources 504 and IDEA/IDEIA

10. 504 Broad Disability Categories Physiological condition Cosmetic disfigurement Anatomical Loss Organic Brain Syndrome Musculoskeletal Disorder Conditions affecting special sense, genital-urinary, respiratory, speech, cardiovascular, or reproductive organs Others IDEA/IDEIA Specific Disability Categories Learning Impairments Mental Retardation Other Health Impairment Visual Impairment Auditory Impairment Traumatic Brain Injury Speech Impairment Autism Spectrum Disorder Emotional Disturbance Orthopedic Impairment 504 versus IDEIA/IDEA

11. In general … Special Education Students are covered under 504 BUT 504 Students are not necessarily Special Education eligible

12. Special Education Admissions, Review, Dismissal (ARD) Committee Membership: Parent(s), Administrator, General/Special Educator, and others as needed 504 504 CommitteeMembership: Parent(s), Administrator, Educator(s), and others as needed Who Decides?

13. Plans of Action Individual Education Plan (IEP)- Special Education 504 Plan- 504

14. Provide routine maintenance of devices (feeding pumps, ventilators, etc.) that are not medically implanted. This is required only to the extent that: The devices are usable within the school setting and needed to provide FAPE (Free and Appropriate Public Education). The devices need not be maintained by a medical professional. Provide medical services required to receive FAPE. In Essence, 504 and IDEA Obligate Schools to … Remember Schools (ARD/504 Teams) decide what services are required, not doctors.

15. So, What about School Nutrition ? Obligations The assurance that unique nutritional needs of students are met if by so doing, the student is able to access a Free and Appropriate Public Education.

16. Federal Funds Prohibit… Usage of Federal Funds to purchase meals or snack items for students

17. Remember … Services beyond those needed to assist students with receiving their education are not the responsibility of the school under IDEA, even if medically required or recommended. (Jose Martin, LLP, 2009)

18. Thus… It must be decided whether a service is solely medical in nature and, as such, not the responsibility of the school under IDEA, or when a service is required educationally.

19. Relevance Any service, equipment or device that bears a direct influence on the ability to provide a free and appropriate public education.

20. Into the IEP • Health Services • Food/Nutrition Services • All relevant supports and services

22. Students with Special Dietsand the role ofHealth Services Julie Lindley, RN, BSNDirector of Health Services & PEGrapevine-Colleyville ISD

23. IHPIndividualized Healthcare Plan • Students whose healthcare needs affect or have the potential to affect safe and optimal school attendance and academic performance require an IHP. • Only Registered Nurses (RNs) may write IHPs.

24. Team Members • Parent(s) • Dietitian • School Nurse • Principal • Student • Cafeteria Manager • Teacher

25. Most Common MedicalConditions Which RequireSpecial Diets in the School Setting • Celiac Disease • Latex Allergies • Crohn’s/Ulcerative Colitis • Diabetics • Food Allergies

26. Celiac Disease • Lifelong autoimmune digestive disorder. • Gluten causes damage to the small intestine. • Gluten is a protein found in wheat, rye and barley. • Treatment is a gluten-free diet.

27. Latex Allergies • Latex allergy is a reaction to certain proteins found in natural rubber latex. • Children with spina bifida have the highest risk for developing a latex allergy. • Foods associated with latex allergies:avocados bananas chestnutskiwis passion fruit • Exposure to latex or the associated foods may cause anaphylactic reactions. • Treatment is food avoidance and epi-pen for a reaction.

28. Crohn’s/Ulcerative Colitis • Also known as Irritable Bowel Disease (IBD) is a chronic disease that causes inflammation and ulceration of the small intestine (Crohn’s) and colon/large intestine (Ulcerative Colitis). • Restriction of high-fiber foods such as nuts, seeds, corn, popcorn, and various Chinese vegetables. • Treatment is a low-fiber/low-residue dietand medications.

29. Type 1 Diabetes • The body does not produce insulin which converts sugar, starches and other food into energy needed for daily life. • Dietary restrictions are not needed, a well balanced diet is recommended. • Students must count the carbohydrates they eat at each meal for insulin administration. • Provide school nurse and families with menus and nutrition information for products served in the cafeteria. • Treatment is a balance of medication/diet/exercise.

30. Food Allergies • Eight foods account for 90% of all food allergiesmilk egg peanut tree nutsfish shellfish wheat soy • Occurs when the immune system mistakenly attacks a food protein causing the release of histamine. • Symptoms of an allergic reaction include:swelling of throat itching/tingling of mouthsensation of warmth difficulty breathingwheezing swelling of the face/mouthhives vomiting/diarrhea • Treatment is food avoidance and epi-pen for a reaction.

31. Tips for a Successful School Plan • Must work as a team! • Education, education, education!diseases anaphylactic reactionsepi-pen use food allergy/food intolerance • Provide school nurse and families with nutrition information for products served in the cafeteria.

33. Accommodating Students with Special Dietary Needs Christina Smith, MS, RD, LS, SNANutrition Services ManagerDallas ISD Food & Child Nutrition Services

34. Our Demographics 150,000 students 68% Hispanic, 26% African American, 4.5% White, 1.5% Asian and American Indian 86% economically disadvantaged Over 300 special diets on record Nearly 200 students with documented diabetes

35. Our Stakeholders and Partners Registered Dietitian and cafeteria staff School nurses and Diabetes educator Parents Speech and Language Pathologist Occupational Therapist ARD coordinator Special Education Community children’s hospitals

36. Our Processes Dietary Order Form Annual Renewals Onsite visits POS Alert Ingredient decks Staff Training Recipes and Menus

38. Our Next Steps Strategies to close the gap Increased automation and training

40. School District Best Practices and Parental Perspectives Sharon Welborn Nicole Notarianni Texas Department of Agriculture

42. Questions and Answers