WSNA Spring Workshop: Ellensburg, April 14, 2007 !. Introductions: Peggy Rieper 2. Review participants’ handouts/materials: 1. PowerPoint presentation handout 2. USDA Guidance: “Accommodating Children with Special Dietary Needs” 3. Handout: “Definition of Recognized Medical Authority” 4. Handout: “Diet Prescription for Meals at School” 5. Sample policies (three) 6. Evaluations 3. Resources: OSPI Food Allergy Kit
Statement is CRITICAL
1. “Person with a disability” : is any person who has a physical or mental impairment which substantially limits one of more major life activities, has a record of such an impaitment, or is regarded as having such an impairment. Examples: cerebral palsy, autism, deafness, blindness, muscular distrophy, multiple sclerosis, cancer diabetes, mental retardation, life threatening food allergy. Special Education: Thirteen disability categories are recognized which establish a child’s need for special edcation and related services. USDA Guidance: p. 3-4 4. IEP (Individualized Education Program) : a written statement for a child with a disability, that contains the program of special education and related services (i.e. dietary services).
All students must be treated equally. WA State Policy for Recognized Medical Authority: identify licensed physicians.
If the child has a disability, the diet order must be signed by a licensed physician and must state what the disability is, and explanation of why the disability restricts the child’s diet, the major life activity affected by the disability, the foods to be omitted/substituted. USDA Guidance: p. 5 REFERENCE: OSPI SAMPLE DIET PRESCRIPTION FORM
Food Anaphylaxis = LIFE THREATENTING REACTIONS
Examples: chopped, ground, pureed foods. Licensed physician’s written instruction is recommended, not required. & 3. Recommend use of commercial nutritive formulas: requires specially trained labor: special ed. Funds may offset costs.
Medically certified as having a special medical or dietary need. Provision coves children who have food intolerances/allergies, but do not have life threatening reactions. Decisions made on a “case by case” basis. USDA Guidance: p. 6
Use same Diet Prescription form. WA State Policy: Defination of Recognize Medical Authority.
WA State Policy: Defination of Recognize Medical Authority. 1. Physician: either a M.D. or a D.O. (Doctor of Osteopathy). 2. Physician Assistant: licensed PA who is licensed to a physician and has prescriptive authority. 3. ARNP: who has prescriptive authority. An ARNP in a school setting does NOT have prescriptive authority. 4. Naturopathic Physician :
Diet prescription is a legal document. Seek clarification through original medical authority that wrote prescription.
Diet prescription must be maintained in the food service area.
All questions/answers can be found in the USDA Guidance: Accommodating Children with Special Dietary Needs. Pages 23-32.
ANSWER: NO: General guideline is that children w/disabilities must be able to participate and receive benefits from programs available to chilldren w/o disabilities. UNLESS specified in IEP. Additional servings may, but need not, be charged to the food service account.
Answer: Same as above.
ANSWER: School has the responsibility to provide safe, non-allergic meals to the child if determined that the condition is disabling . All food items offered must meet prescribed guidelines. Check food labels/contact supplier or manufacturer. Contact Food Allergy & Anaphylaxis Network General Rule: exercise caution at all times.
ANSWER: SFA may make substitutions, but not required to. If LEA decides to accommodate, must have supporting statement, signed by recognized medical authority on file.
ANSWER: YES Accommodations must be made regardless of whether the school district operates the food services itself of contracts with a FSMC.
ANSWER: When the school purchases/sells the product itself, the fast-food chain incurs no more obligations than any other wholesaler or retailer of food products. Technically, “ala carte” items are not part of reimbursable meal: not subject to program regulations. Advise obtaining specific ingredient information from vendor.
ANSWER: In general, children must be allowed to participate w/other children to the maximum extent possible. Many not segregate children w/disabilities on the basis of convenience to school or other children.
ANSWER: If disability restricts child’s diet, substitutions/modifications must be provided regardless of duration.
ANSWER: Most instances: food services will pay the cost of food, prep, personnel. Addvised to use commercial nutritive formulas. Required special labor costs – may be covered through special ed. Funds if IEP exists, or general fund/other funding sources if no IEP
ANSWER: NO A list of appropriate substitutions should accompany the menus and the foods should be on hand on a regular basis.
ANSWER: YES Not required, houwver, these supplements are a legitimate charge to the food service account.
ANSWER: YES The food service account may only pay for the amount of time that the person actually spends on activities related to the school food service.
ANSWER: Must ask parents to obtain more written information from the physician. May be appropriate for pysician to provide written referral to R.D. or nutrition professional.
R.D. or nutrition professional Special ed. Teacher or health professional in feeding.
Covers certain low income individuals/families.
OSPI Food Allergy Kits Provide technical assistance on American with Disabilities Act R.D.s Spokane SD Allergy Website: http:www.spokaneschools.org/NutritionServices/Allergies/default.stm LEAs are required to develop/maintain written procedures describing the processing of special needs requests. Review two sample policies.
Oversee programs for children w/special health care needs: public health nutritionists Provide families/individuals with variety of support services. Thank you for coming today. Please complete your evaluations and leave them here. Safe travels home!
Accommodating Children with Special Health Care Needs
Accommodating Children with Special Dietary Needs
Schools must make substitutions in foods in the reimbursable meal for students who are disabled and whose disability restricts their diet .
What are Disabilities? • Disability is defined in: * Section 504 of the Rehabilitation Act of 1973 * Americans with Disabilities Act of 1990 * Part B of the Individuals with Disabilities Education Act (IDEA) * IEP
Disability <ul><li>Accommodation MUST be made </li></ul><ul><li>No extra charge </li></ul><ul><li>A disability determination can only be made by a licensed </li></ul><ul><li>physician </li></ul>
Statement For Children With Disabilities <ul><li>What the disability is </li></ul><ul><li>How it restricts diet </li></ul><ul><li>Major life activity affected </li></ul><ul><li>Foods to be omitted </li></ul><ul><li>Foods to be substituted </li></ul>
Food Related Disabilities <ul><li>Diabetes </li></ul><ul><li>PKU </li></ul><ul><li>Food Anaphylaxis </li></ul>
Other Food Accommodations <ul><li>Texture </li></ul><ul><li>IV </li></ul><ul><li>Tube Feeding </li></ul>
Children Who Are Not Disabled But Have Other Special Dietary Needs <ul><li>Food allergies or intolerances </li></ul><ul><li>• NOT generally disabilities UNLESS anaphylactic </li></ul><ul><li>Accommodation MAY be made BUT is NOT required </li></ul><ul><li>In many cases, allergies can be dealt with through </li></ul><ul><li>“ Offer Versus Serve” or by providing additional selections </li></ul>
Statement For Children Who Are Not Disabled <ul><li>The substitutions must be supported by a statement signed by a recognized medical authority (physicians, physician assistants, nurse practitioner, or other professionals) specified by the State agency. </li></ul>
Statement For Children Who Are Not Disabled (continued) <ul><li>The statement must include: </li></ul><ul><li>• an identification of the medical or other special </li></ul><ul><li>dietary condition which restricts the child’s diet, </li></ul><ul><li>• the food or foods to be omitted from the child’s </li></ul><ul><li>diet; and </li></ul><ul><li>• the food or choice of foods to be substituted. </li></ul>
NEVER <ul><li>Revise or Change a Prescription or Medical Order </li></ul>
School Food Service Records <ul><li>It is important that all recommendations for accommodations or changes to existing diet orders be documented in writing to protect the school and minimize misunderstandings. Schools should retain copies of special, non-meal pattern diets on file for reviews. </li></ul><ul><li>The diet orders do not need to be renewed on a yearly basis; however, schools are encouraged to ensure that the diet orders reflect the current dietary needs of the child. </li></ul>
Commonly Asked Questions <ul><li>These questions are grouped under the following topics: </li></ul><ul><li>• Meals and/or foods outside of the normal meal service </li></ul><ul><li>• Special needs which may or may not involve disabilities </li></ul><ul><li>• Responsibilities of food service management companies and other food service operations </li></ul><ul><li>• Feeding in separate facilities – generally not acceptable </li></ul><ul><li>• Temporary disabilities </li></ul><ul><li>• Complicated feeding </li></ul><ul><li>• School food service account; and </li></ul><ul><li>• Documentation </li></ul>
Meals and/or Foods Outside of the Normal Meal Service <ul><li>Situation: </li></ul><ul><li>As part of the therapy for a child with a disability, the licensed physician has required the child to consume six cans of cranberry juice a day. The juice is to be served at regular intervals, and some of these servings would occur outside of the normal school meal period. Is the school food service required to provide all of the servings of juice? </li></ul>
Meals and/or Foods Outside of the Normal Meal Service (continued) <ul><li>Situation: </li></ul><ul><li>A child with a disability must have a full breakfast each morning. Is the school food service required to provide a breakfast for this child even though a breakfast program is not available for the general school population? </li></ul>
Meals and/or Foods Outside of the Normal Meal Service (continued) <ul><li>Situation: </li></ul><ul><li>A licensed physician has prescribed portion sizes that exceed the minimum quantity requirements set forth in the regulations. Is the school required to provide these additional quantities? </li></ul>
Special Needs Which May or May Not Involve Disabilities <ul><li>Situation: </li></ul><ul><li>A child has a life threatening allergy which causes an anaphylactic reaction to peanuts. The slightest contact with peanuts or peanut derivatives, usually peanut oil, could be fatal. To what lengths must the food service go to accommodate the child? Is it sufficient for the school to merely avoid obvious foods, such as peanut butter, or must school food service staff research every ingredient and additive in processed foods or regularly post all of the ingredients used in recipes? </li></ul>
Special Needs Which May or May Not Involve Disabilities (continued) <ul><li>Situation: </li></ul><ul><li>A child has a health condition that does not meet the definition of “disability” set forth in the legislation and regulations. For example, the child is overweight (but not “morbidity” so), or the child has elevated blood cholesterol. Is the school obligated to accommodate the special dietary needs of this child? </li></ul>
Special Needs Which May or May Not Involve Disabilities (continued) <ul><li>Situation: </li></ul><ul><li>A child’s parents have requested that the school prepare a strict vegetarian diet for their child based on a statement from a health food store “nutrition advisor” who is not a licensed physician. Must the school comply with this request? </li></ul>
Responsibilities of Food Service Management Companies (FSMC) And Other Food Service Operations <ul><li>Situation: </li></ul><ul><li>A school district has contracted with a FSMC to operate the school’s food service. Is the FSMC obligated to accommodate children with disabilities? </li></ul>
Responsibilities for FSMC And Other Food Service Operations (continued) <ul><li>Situation: </li></ul><ul><li>Some schools purchase items from nationally recognized fast-food chains and sell these items on an “ala carte” basis. These items are frequently sold in a setting such as a kiosk which uses the chain’s logo or otherwise advertises the product. What obligation, if any, does the fast-food chain have to provide alternative meals? </li></ul>
Feeding In Separate Facilities – Generally Not Acceptable <ul><li>Situation: </li></ul><ul><li>A school wishes to serve meals to children with disabilities in an area separate from the cafeteria where the majority of school children eat. May the school establish a separate facility for these children? </li></ul>
Temporary Disabilities <ul><li>Situation: </li></ul><ul><li>A child was involved in an accident and underwent major oral surgery. As a result, the child will be unable to consume food for a period of time unless the texture is modified. Is the school obligated to make this accommodation even though the child will not be permanently disabled? </li></ul>
Complicated Feedings <ul><li>Situation: </li></ul><ul><li>A child enrolled in the school will require tube feedings. Is the food service only required to pay for and provide the food, or are the costs for the school nurse, an aide or a specially trained professional to administer the feeding also assigned to the food service? </li></ul>
Complicated Feedings (continued) <ul><li>Situation: </li></ul><ul><li>A child with a disability is on a number of medications. The physician’s statement is well defined and includes menus with specific foods. If a situation arises where specific foods are out of stock, should school food service make substitutions on an “as necessary” basis? </li></ul>
School Food Service Account <ul><li>Situation: </li></ul><ul><li>A child with a disability needs to consume six cans of a nutritional supplement during the school day: two cans at breakfast, one can as a mid-morning snack, two cans at lunch, and one can as a mid-afternoon snack. The cost of the breakfast and lunch supplements is allowable food service expenses. If the school chooses to offer the additional supplement at the mid-morning and mid-afternoon snack period, are these allowable costs to the food services account? </li></ul>
School Food Service Account (continued) <ul><li>Situation: </li></ul><ul><li>A child with a disability requires the services of the school nurse for assistance in feeding at lunch. Can the food service account be billed for the services of non-food service personnel such as the school nurse or special aide who may be assisting in the feeding of the child or other nutrition related activity? </li></ul>
Documentation <ul><li>Situation: </li></ul><ul><li>The physician’s statement only specifies the medical disability, not the required food substitutions. What should the food service director do? </li></ul>
Funding <ul><li>INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA) </li></ul><ul><li>• Services which may be funded through IDEA </li></ul><ul><li>* Special Foods, Supplements, Equipment </li></ul><ul><li>* Consultation Services </li></ul><ul><li>* Assistance </li></ul>
Funding <ul><li>MEDICAID </li></ul><ul><li>• Varies from State to State </li></ul><ul><li>• Paid Directly to Provider </li></ul>
Funding <ul><li>LOCAL </li></ul><ul><li>• PTA </li></ul><ul><li>• Voluntary Health Associations </li></ul>