Management of Special Diets in Schools: A Team Approach

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, SNSDistrict Child
  Nutrition Director
• Trey McMinn, RN, BSNDistrict Health Services
  Coordinator School Nurse for McRae Elementary
• Suzanne Pitts, RN, BSNSchool Nurse, Sidney
  Deener Elementary School
• Esther HuffmanSchool Child Nutrition
  ManagerMcRae Elementary School
• Donna FranksSchool Child Nutrition
  ManagerSidney 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, 2nd 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 childs 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 staffif 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?