Finding the Best Written Care Plan for Your Child
School-age children spend about half their waking hours at school, and children with diabetes are no different. Since children can’t leave their diabetes at home when they go to school, having a plan — preferably a written plan — is necessary for managing their diabetes while they’re at school.
Such a plan should be individualized and should cover a 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 where teachers and other school personnel, such as the nurse, can access it easily.
Types of plans
One way to lay out your child’s diabetes management needs in school is the Diabetes Medical Management Plan (DMMP), developed by the American Diabetes Association and the National Diabetes Education Program. A DMMP gives instructions for managing your child’s diabetes and provides guidance for handling emergencies. In many cases, putting together a DMMP and discussing it with teachers and other school staff are sufficient to make sure your child’s diabetes-related needs are met during school hours.
Implementing a DMMP: If you’d like to implement a DMMP for your child, talk with your child’s health-care team and include input from your child if he or she is old enough. Once the DMMP is developed, meet with school staff to discuss how the plan will be executed. The DMMP is to be reviewed and updated before each school year if your child’s treatment plan has changed, or if there is a change in the school schedule.
However, if you feel that your child’s diabetes is not being cared for properly under the DMMP, or if your child is being discriminated against because of his or her diabetes, (for example, if a gym teacher regularly prohibits your child from participating in gym activities for fear he or she will 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. A 504 plan helps ensure that a child’s special needs are met, which may include extended time on tests, preferential seating, short breaks, etc.
A 504 plan is an agreement between a student and a school team, consisting of the principal, teachers, and other school personnel, that the student will have full access to all school activities and will have his or her medical needs met. This type of plan is similar to a DMMP, but it is also legally binding, whereas a DMMP is not.
Typical provisions in 504 plans include: (Source: ADA)
• School staff trained on how to check blood glucose levels and administer insulin and glucagon.
• School staff trained to recognize high and low blood glucose levels, and respond appropriately
• Capable students are allowed to self-manage anywhere, anytime, and keep their diabetes supplies with them.
• Needed assistance is provided in the classroom to increase safety and decrease missed class time.
• Full participation in all sports, extracurricular activities, and field trips, with the necessary diabetes care assistance and/or supervision provided.
• Permission to eat whenever and wherever necessary, including eating lunch at an appropriate time with enough time to finish eating.
• Permission to take extra trips to the bathroom or water fountain.
• Permission for extra absences for medical appointments and sick days without penalty.
• Alternate arrangements for classroom time missed for medical appointments because of periods of high or low blood glucose, or illness related to diabetes.
If a student with diabetes has special education needs, an Individualized Education Plan (IEP) may be necessary, based on the DMMP for the student’s diabetes management routine. Rules and guidelines pertaining to IEPs are found in the Individuals with Disabilities Education Act (IDEA), which provides extra federal funding to state and local education agencies.
To qualify for an IEP, a child must have an impairment that affects his or her academic performance. A child who has had to miss many school days due to diabetes complications, and is doing poorly in class as a result, for instance, might qualify for an IEP. Under the law, an IEP must contain certain information, including the child’s current level of academic performance, the services that he or she 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, and it must be reviewed and revised yearly, although evaluations can be conducted more frequently.
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.
Both a 504 plan and an IEP are formal, legal documents, which means the school is legally bound to implement the practices laid out by the plan. One or the other may be particularly useful in situations involving prior difficulties at school; or when a student is taking timed, standardized tests, or going through a transitional period such as a change of school or teachers.