Updated August 31, 2006

School Planning 101

by Margaret T. Lawlor, M.S., C.D.E., and Cindy Pasquarello, B.S.N., R.N., C.D.E.

School-age children spend about half their waking hours at school, and children with diabetes are no different. Since your child can’t leave his diabetes at home when he goes to school, it is necessary to have a plan—preferably a written plan—for managing his diabetes while he is at school. Such a plan should be individualized and should cover your child’s daily diabetes care as well as provide instructions for handling problems, emergencies, and any unusual situations that may arise during the school day. Copies of the plan should be kept at school so that your child’s teachers and other school personnel such as the nurse can access it easily when it is needed.

Types of plans
One format for laying out your child’s diabetes management needs in school is the Diabetes Medical Management Plan (DMMP), which was developed by the American Diabetes Association. A DMMP includes such information as who is responsible for particular diabetes management duties, instructions for what to do in emergency situations, and guidelines for attending to the child’s needs. (For information on getting a sample plan, see "School Plan Resources.") In many cases, putting together a DMMP and discussing it with teachers and other school staff is all that is needed to make sure a child’s diabetes-related needs are attended to at school.

However, if you feel that your child’s diabetes is not being cared for properly in school in spite of having a DMMP in place or if he is being discriminated against because of his diabetes (for example, if a gym teacher regularly prohibits him from participating in gym activities for fear he’ll develop hypoglycemia), you may ask for a 504 plan to be developed.

Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits disability-based discrimination in all programs that receive or benefit from federal financial assistance. While this law does not provide extra federal funding to schools, a program failing to comply with Section 504 can lose the funding that it currently receives.

A 504 plan is an agreement between a student and a school district that the student will have full access to all school activities and will have his medical needs met. This type of plan includes information similar to that contained in a DMMP but is legally binding, where a DMMP is not.

If a student with diabetes has special education needs, an Individualized Education Plan (IEP) may be developed, using the DMMP as a foundation for details on the student’s diabetes management routine. Rules and guidelines pertaining to IEPs are found in the Individuals with Disabilities Education Act (IDEA), which provides some extra federal funding to state and local education agencies to ensure the viability of special educational services. These services are implemented to provide a free and appropriate education to students with special needs, as IDEA establishes it is the right of these students to receive.

To qualify for an IEP, a child must have an impairment that affects his academic performance. A child who has had to miss many school days due to diabetes complications and is doing poorly in his classes as a result, for instance, might qualify for an IEP. Under the law, there is certain information that an IEP must contain, including the child’s current level of academic performance, the services that he is to receive, and an evaluation and revision schedule for the IEP. The plan should be created in collaboration with the child’s parents, health-care team, teachers, and perhaps the child himself, and it must be reviewed and revised yearly, although evaluations can be conducted more frequently if desired. If the parents are unhappy with the performance of the plan, or if it no longer reflects the student’s needs, they can initiate a process to adjust the plan at any time. If, after revision, the parents still do not feel that the plan is adequate, they can refuse to sign it and try to reach an agreement or facilitate a change with the help of an outside source.

Also in this article:
School Plan Resources

Margaret Lawlor is the Coordinator of Pediatric Research and Education and Cindy Pasquarello is a Pediatric and Adolescent Diabetes Nurse Specialist at the Joslin Diabetes Center in Boston, Massachusetts.

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