Summer is almost over and a new school year is about to begin. Those long, lazy days may be ending, but for schoolkids with diabetes, one thing doesn’t end: diabetes care. Diabetes never skips a day of school, so parents need to make sure their child is getting the proper diabetes care throughout the school day. Fortunately, laws exist to make sure children with diabetes and other conditions are safe at school and have the same opportunities as everyone else. Here is an overview of your child’s rights at preschool, elementary, middle, and high school, given by pediatric endocrinologist Dr. Tariq Ahmad:
The law is on your side
There are several laws that deal with disabilities and accommodations at school. The first three listed here are federal laws. California and other states also have laws protecting individuals with disabilities.
1) Americans with Disabilities Act (ADA)
The ADA was enacted in 1990 as an anti-discrimination law protecting people with disabilities. Generally speaking, a disability is defined as “a physical or mental impairment that substantially limits one or more major life activities”. The ADA prohibits schools, child care programs, camps,and other child care centers from treating children with disabilities unfairly. Title I of this law applies to the work environment, Title II applies to all public schools, and Title III applies to private schools. Private schools with a religious affiliation are excempt. However, Section 504 (see below) still protects your child if his or her religiously affiliated private school receives federal funding.
2) Section 504 of the Rehabilitation Act (Section 504)
Section 504 is another anti-discrimination law. anti discrimination law. It protects your child at any school, child care program, camp, or other child care center that receives federal funding. The law applies even when that institution is run by a religious organization if the institution receives federal funds. Many private schools, including religious affiliated programs, receive federal funding in the form of food vouchers, financial aid, scholarship grants, reduced or free rent at public facilities, etc..
3) Individuals with Disabilities Education Act (IDEA)
This federal law provides funding and accommodations for a child, should the school find the child has a disability. Some children may need an Individualized Education Program (IEP) if there is proof that the student’s disability is harming their ability to learn. Federal funding provides the institution the resources to provide these services.
4) Other local laws
Your state may have other laws that protect people with disabilities from discrimination. For example, California has state laws that protect schools and daycares from liability. For example, under California law, individuals (including those at daycare and at school) are not liable for good faith efforts to assist in an emergency. California law also allows daycares to administer prescription medicine. For a person with diabetes, this means that parents can assign a trained individual, not necessarily a nurse, to administer glucagon and insulin to their child. Similarly, California law allows trained child care staff or staff at school to administer glucagon or insulin in the absence of a health professional.
Initial steps parents should take with schools
Contact your school
Inform anti-discrimination personnel, principal or school nurse about your child’s diabetes and let them know you need help. Once you let them know, it is the school’s responsibility to provide the necessary accommodations for your child. Note, it does not matter how long ago your child was diagnosed. Also, it does not matter if the school is public or private, unless the school is religiously affiliated and receives no federal funding.
Here are some tips when submitting a formal request:
- State the purpose of the request.
- Describe the limitations caused by the disability (i.e lack of ability to communicate, concentrate, etc..)
- Give details on how the condition will affect the skills and abilities expected of the student — including both life and academic skills and abilities
- List the types of accommodations requested
- Provide medical documentation of the disability (by medical team, i.e. doctors note)
- Offer to participate in any needed evaluation or meeting to discuss accommodations
Parents should provide consent so that your child’s medical team can share relevant information with designated school staff.
Schools are not required to provide diabetes supplies such as testing equipment, glucagon, insulin, and low snacks.
Be a resource
If the school does not have a dedicated nurse, make sure that at least one staff member is trained and available to give insulin or glucagon. You or your diabetes team can provide training to school staff members. You can also talk to your child’s teacher and explain what your child needs in order for him or her to succeed in class. Many small schools are fearful of liability. This fear stems from the unknown, so education and training can help dispel that fear.
Write everything down
Keep a log of all relevant communications and conversations that go between you and the school and the physician. It is useful to ask the school to put a time stamp on printed communication.
Forms and documents
Below are some forms you will encounter in the process of obtaining accommodations for your child’s diabetes at school:
Diabetes medical management plan
A diabetes medical management plan is a medical order prepared by your child’s physician. It discusses medical aspects of your child’s diabetes care. The plan specifies how much insulin your child needs, and when and where to give it. The plan also discusses procedures such as what to do when blood sugars go high or low.
Unlike a diabetes medical management plan, a 504 plan is not typically prepared by a doctor. Rather, the school works with parents to develop the 504 plan. In essence, the 504 plan is an overall care plan for your child. It contains the who, what, where, when, and how your child will be care for at school. It should also have a plan for field trips, athletic events, and the like.
The 504 plan can be a powerful document. It is your chance to provide instructions to your child’s school about issues such as:
- Accommodations during field trips and extra-curricular activities
- Access to food, water, restrooms
- How meals will be stores and disposed
- When parents or physician should be contacted
- Evacuation plans
- Who will monitor for symptoms
- Who will give glucagon and insulin
- Test taking accommodations
- No penalties for diabetes-related infringements such as missed classes
Schools must let parents know that 504 plans are available for students, but the onus is on parents to request one. The school will form a team or panel and meet with parents to discuss what should be on the 504 plan. The school will have a designated person to write up the 504 plan. Ideally, the person will be someone familiar with type 1 diabetes and familiar with your child. Your child’s medical team — physician, nutritionist, social worker, CDE, nurse, and psychologist — can be a great resource during this process.
Some schools may ask you to sign a waiver before your child begins school. Parents are not required to sign liability waivers. In fact, a liability waiver is prohibited in public K-12 schools in California in most cases. However, schools may require special waivers for athletic teams, field trips, and special outdoor school programs. Also, parents should consent to allow the school to communicate with their child’s medical team.
Here are some useful things to know about your child’s rights at school:
- Children with disabilities cannot be excluded from extra curricular activities
- Parents do not have to accompany their children on field trips, athletic events, or go to school
- Parents should not have to pay extra for disability accommodations
- Schools should have carb counts available for the foods they are providing
- Children may not be academically penalized for medically excused absences. Extra curricular activities are an exception; for example, a coach cannot guarantee playing time for a child with too many absences.
- There are no forbidden foods, Children with diabetes should be allowed to have the same things (ie class parties)
- A student can attend to their diabetes ANYWHERE (in classroom, in locker, etc…)
- When your child has an emergency that requires glucagon, the school should not call 911 in place of administering glucagon. A trained person should give the glucagon.