Region One FNP Kimberly Keller 1/21/15 · Strategies, Best Practices, & Key Reminders Question & Answers Helpful Resources Review of Case Studies ... Note: Lactose free milk is NOT

Region One FNP

Kimberly Keller

1/21/15

2015 Region One Education Service Center

Acknowledgement Statement• You understand and acknowledge that

• the training you are about to receive does not cover the entire scope of the program; and that

• you are responsible for knowing and understanding all handbooks, manuals, alerts, notices and guidance, as well as, any other forms of communication that provide further guidance, clarification or instruction on operating the program.


Objectives Defining & Understanding Disability Laws

Requirements for Physician and/or Medical Statements

School Foodservice Responsibilites

Understanding the Fluid Milk Substitution Rule

Looking at Various School Issues

Accommodating Special Diets – Review of Common Scenarios


Objectives Allowing Variations for Religious Reasons

Examining Diet Orders

Strategies, Best Practices, & Key Reminders

Question & Answers

Helpful Resources

Review of Case Studies

Class Conclusion



Introduction The U.S. Department of Agriculture’s (USDA)

nondiscrimination regulation (7 CFR 15b), as well as the regulations governing the National School Lunch Program and School Breakfast Program, make it clear that substitutions to the regular meal must be made for children who are unable to eat school meals because of their disabilities, when that need is certified by a licensed physician.


What are the Disability Laws? Laws and regulations to ensure children with

disabilities have access to USDA CNP

The Rehabilitation Act of 1973 (Section 504)

Americans with Disabilities Act

Individuals with Disabilities Education Act Individualized Education Program (IEP)

ADA Act Amendments of 2008

7 Code of Federal Regulations Part 15b – USDA Regulations

7 Code of Federal Regulations 210.10(g) – NSLP


Disability Law Rehabilitation Act of 1973 & the Americans with

Disabilities Act (Under Section 504)

A “person with a disability” means any person who has a physical or mental impairment which substantially limits one or more major life activities

The term “physical or mental impairment” includes many diseases and conditions, a few include:


Disabilities Include:Orthopedic, visual, speech, and hearing impairments

Food Anaphylaxis

Cerebral Palsy Mental Retardation

Epilepsy Emotional Illness

Muscular Dystrophy Drug addiction, alcoholism

Cancer Specific Learning Disabilities

Heart Disease HIV Disease

Metabolic Disease (Diabetes, phenylketonuria (PKU))

Tuberculosis


Major Life Activities Include: Major life activities covered by this definition include:

Caring for one’s self

Eating

Performing manual tasks

Walking

Seeing

Hearing

Speaking

Breathing

Learning

Working


Section 504 & Written Management Plans USDA states in its guidelines for accommodating

students with special dietary concerns that when the physician diagnoses a food allergy as potentially causing life threatening reactions, the child’s condition meets the definition of a disability under Section 504

Disability Law Continued Individuals with Disabilities Education Act (IDEA)

A “disability” under Part B of IDEA means a child evaluated in accordance with IDEA as having one or more of the recognized thirteen disability categories

The thirteen disability categories establish a child’s need for special education and related services.


Disabilities Include:Autism Emotional Disturbance

Deaf-Blindness Specific learning Disabilities

Deafness, Hearing Impairments Speech or Language Impairment

Mental Retardation Traumatic Brain Injury

Orthopedic Impairments Visual Impairment

Chronic or Acute health problems (asthma, diabetes, tuberculosis)

Multiple Disabilities

Attention deficit disorder or attention deficit hyperactivity disorder may fall under one of the thirteen categories.


Individual Education Program (IEP) IEP is a written statement for a child with a disability

that is developed, reviewed, and revised in accordance with IDEA and it implementing regulations

The IEP will contain the related services to be provided to a child with a disability covered under IDEA


IEP Continued IEP may be supplemented with a written statement to

address a students nutritional needs OR

A “Health Care Plan” is another written statement used by some states to address nutritional needs

School officials need to involve school food service early on to be involved in the decision making process regarding school meals


ADA Amendments Act of 2008 Amends federal definition of disability to include

additional individuals

Broadens definition of “major life activity” and includes “major bodily functions”

May increase number of individuals diagnosed and requesting accommodations

Policy Memo SP 36-2013


Defining Major Life Activities & Bodily FunctionsMajor Life Activity Major Bodily Functions

Caring for oneself Immune Function

Performing manual tasks Normal cell growth

Seeing Digestive

Hearing Bowel

Eating Bladder

Sleeping Neurological

Walking Brain

Standing Respiratory

Lifting Circulatory

Bending Cardiovascular

Speaking Endocrine

Reading Reproductive functions

Concentrating

Thinking

Communications

Physician Statement - Disability The physician’s statement must identify:

The child disability

An explanation of why the disability restricts the child’s diet

The major life activity affected by the disability

The food or foods to be omitted from the child’s diet, and the food or choice of foods that must be substituted


What is the Definition of a Disability? Disability

A condition that substantially limits one or more major life activities; or

A record of such a condition; or

Being regarded as having such a condition.


What to do in cases with Food Allergies? In most cases, child with food allergies (non-life

threatening) or intolerances do not have a disability

School food service may, but is not required to make food substitutions for them

When a licensed physician’s assessment identifies that the food allergy will result in a severe, life threatening reaction, the condition becomes a disability and the diet prescription must be accommodated by school food service


Who Establishes when a Food Allergy is Considered a Disability? Licensed Physician

Disability must be determined by a licensed physician and a written statement must be provided


Defining A Licensed Physician Licensed physician

A fully trained physician who is licensed by the State to prescribe medication or to perform surgery.


Recognized Medical Authority Physician

Physician Assistant

Nurse Practitioner

Other professionals specified by the State Agency

Food Allergy vs. Food Intolerance Food Allergy

Is an abnormal immune response to a certain food that the body reacts to as harmful

Food Intolerance

Is an adverse reaction to food that does not involve the immune system

Milk Allergy vs. Lactose Intolerance


Are all Food Allergies Life Threatening? When a food allergy result in an anaphylactic reaction,

it can potentially become a life threatening condition

Anaphylaxis is a potentially life threatening condition

Exposure to food allergens is the most common cause of anaphylaxis – peanut, tree nuts, fish and shell fish


Common Food Allergens Top Food Allergens

Cow’s Milk

Eggs

Peanuts

Tree Nuts

Fish

Shellfish

Soybeans

Wheat2015 Region One Education Service Center

Other Special Dietary Needs School food service may make food substitutions, at

their discretion, for individuals with conditions not considered a disability

Determinations are to be evaluated on a case-by-case basis

Examples: food intolerances, allergies that do not result in a life-threatening reaction


Medical Statement – Non-Disability

Each special dietary request must be supported by a statement that explains the food substitution that is requested

It must be signed by a recognized medical authority


Recognized Medical Authority Physician

Physician Assistant

Nurse Practitioner

Other professionals specified by the State Agency


Medical Statement – Non-Disability

The medical statement must include:

Identification of the medical or other special dietary condition which restricts the child’s diet;

The food or foods to be omitted from the child’s diet; and

The food or choice of foods to be substituted


School Food Service Responsibility – Disability Dietary Accommodations must be made when the

condition is determined to be a disability

The disability determination can only be made by a licensed physician

The accommodations can not be at the expense of the student and/or family

School FS can not revise, interpret, or change an existing diet prescription or medical order


School Food Service Responsibility –Non-Disabilities Schools are encouraged to make accommodations

Accommodations can be evaluated and implemented on a case by case basis


School Food Service Responsibilities 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

Diet orders do not need to be renewed on a yearly basis; however schools should ensure that active diet orders reflect the current dietary needs of the child


Providing Special Meals - Disability School Food Service is required to offer special meals, at no

additional cost, to children whose disability restricts their diet.

If a child’s IEP includes a nutrition component, the school food service should be involved to accommodate meal modifications

School food service is not required to provide meal services to children with disabilities when the meal service is not normally available to the general student body, unless it is stated under a child’s IEP


Example: School District A does not offer a school breakfast

program. The school food service would not be required to provide breakfast to a student with a recognized disability, unless it is specified in the child’s IEP.

School District A has a student in special education that has an IEP. The IEP indicates that the child needs breakfast at school, in this case the school would be required to provide the meal.



Fluid Milk Substitution Rule The final rule, Fluid Milk Substitution in the School

Nutrition Program was published on September 12, 2008

Rule addresses the following:

Fluid milk substitutions for non-disabling allergies, culture, religious, and ethical beliefs

Set nutrition standards for non-dairy milk substitutes offered as part of the reimbursable meal


Fluid Milk Substitution Rule Schools MAY make substitutions for non-disabled

students due to the following needs: Medical or Special Dietary Need – lactose intolerance,

dairy allergies (non-life threatening)

Cultural or Religious Dietary Restrictions

Fluid Milk Substitution can be offered to all students if the following criteria is met: Approved Fluid Milk Substitute

Offered as part as a Reimbursable Meal

Students are not charged to pay extra for milk substitute


Current Approved Milk Substitutes

Pacific Natural Food – Ultra Soy Plain

Pacific Natural foods – Ultra Soy Vanilla

Stremicks Heritage Foods – 8th Continent Soy Milk Original

Kikkoman – Pearl Soy, all flavors

Sunrich Natural Original and Vanilla


Non-Dairy Beverage Nutritional StandardsNutrient Per Cup

Calcium 276 mg

Protein 8 g

Vitamin A 500 IU

Vitamin D 100 IU

Magnesium 24 mg

Phosphorus 222 mg

Potassium 349 mg

Riboflavin 0.4 mcg

Vitamin B-12 1.1 mcg


Non-Dairy beverages must provide the nutrients listed in the above table.

Notifying TDA Contracting Entities must inform TDA in writing

There must be a written notification that is submitted to TDA on CE letterhead of their decision to offer a fluid milk substitution prior to purchase

Notification may be submitted via postal service, fax, and/or email

Note: Lactose free milk is NOT considered a milk substitute because it meets the definition of fluid milk. Lactose free milk can be found in the Food Buying Guide.


Fat Content & Fluid Milk Substitutions Fluid milk substitutions such as soy milk are not

subject to the fat content regulations that apply to regular fluid milk

A fluid substitution may have a higher fat content than fat free (skim) and 1% (low fat)


Q & A – Final Fluid Milk Substitution Rule 1. What are the main changes prompted by the final

rule?

Allows parent/guardian to request a fluid milk substitute for a student that has a special dietary need that is not considered a disability

Establishes nutrient standards for non-dairy beverages

2. Does the final fluid milk substitution rule apply to the NSLP, SBP, ASCP and SSO?

YES


Q & A – Final Fluid Milk Substitution Rule 3. Is a meal without fluid milk or an acceptable milk

substitute reimbursable?

It depends.

Under, Offer vs. Serve (OVS), a meal without fluid milk can be reimbursable.

If there is no Offer vs. Serve, a reimbursable meal must include milk or an acceptable milk substitute (exception for disabled students)


Q & A – Final Fluid Milk Substitution Rule 4. Must the school offer a milk substitute for a student

with a medical or special dietary need at the request of a medical authority or a parent?

No, a school has the discretion to offer a milk substitute as part of the reimbursable meal to a student with a special dietary need other than a disability.


Q & A – Final Fluid Milk Substitution Rule 5. Must a school comply with a statement from a

licensed physician or a medical authority indicating that a specific beverage (e.g., juice) must be provided in place of milk to a student with a medical or special dietary need other than a disability?

No, a school needs to comply with a statement from a licensed physician only when a milk substitution is necessary due to a disability.


Q & A – Final Fluid Milk Substitution Rule 6. If a school chooses to offer milk substitutes for

children with medical or special dietary needs, may it only accept written requests from medical authorities?

No, the school does not have the option to refuse a parent’s request. Regulations allow a statement from the parent/guardian, as well as, a medical authority.


Q & A – Final Fluid Milk Substitution Rule 7. What type of documentation must be submitted to

the school to request a milk substitute for a student who does not have a disability?

The written request from the medical authority or the parent/guardian must identify the student’s medical or other special dietary need that precludes the consumption of cow’s milk. No other information is required.


Q & A – Final Fluid Milk Substitution Rule 8. Do the regulations prohibit a school food service

operation from offering students with medical or special dietary needs a milk substitute that does not meet the nutrient standards in the Final Rule?

If a meal includes a milk substitute that does not meet the requirements of the rule (e.g. juice), no reimbursement would be provided for that meal.


Q & A – Final Fluid Milk Substitution Rule

11. Should lactose free milk always be the substitute for a non-disabled student with lactose intolerance, even if the written statement indicates that water or juice should be provided?

Water or juice can no longer be offered as a fluid milk substitute for a student with medical or special dietary needs. For practical reasons, lactose free milk should be the first choice for a student who has lactose intolerance. Lactose free milk provides the same key nutrients found in regular cow’s milk and is readily available nationwide. Furthermore, USDA FNS allows lactose free milk to be provided as part of the reimbursable meal without documentation.



12. Is water an allowable substitute for milk and does it need to be fortified?

Water is not considered an acceptable substitute for fluid milk. Only a beverage meeting the nutrient standards at levels specified above may be substituted for fluid milk.



13. May a school decline to offer an acceptable milk substitute to students with medical or special dietary needs, other than disabilities, due to cost?

Yes, a school has the choice to accommodate a milk substitution request from a child with medical or special dietary needs other than a disability.

Because milk substitution requests are granted on a case-by-case basis and a school selects the acceptable non-dairy beverage(s), TDA anticipates that in most cases the substitution could be accommodated without undue financial hardship.



14. May a school claim a meal that includes four food components (other than fluid milk) and beverages brought from home, as indicated by a medical authority or a licensed physician?

Under OVS, a meal without fluid milk can be reimbursable.

If there is no OVS, a reimbursable meal for a child with a medical or special dietary need must include milk or an acceptable milk substitute provided by the school as part of a reimbursable meal.



15. Does a school have to accept milk substitution requests even if it is not offering a milk substitution for students with medical or special dietary needs.

If a school decides not to offer a milk substitution for students with medical or special dietary needs, it should communicate this decision to all households a the beginning of the school year to minimize the number of written requests.

TDA does not expect schools to keep documentation of non-disability milk substitution requests that are not being implemented.



Family’s Responsibility Provide the school with an Allergy Action Plan (has

physician signature)

Provide medication dosage and administration instructions

Complete and submit all school required medical forms

Schedule a meeting with school staff as needed

Develop a plan for classroom parties, field trips, and unexpected events


Student’s Responsibility Students should not:

Trade food or share drinks and utensils with others

Consume food items with unknown ingredients or that is known to contain any allergens

Students should: Be proactive in the care and management of their food allergies and

reactions

Understand the importance of hand washing before and after eating (BIC)

Immediately notify an adult if they suspect they have consumed a food and/or beverage that they are allergic too

Notify an adult if they are being bullied due to their food allergies


CNP’s Responsibility Department Responsibilities Include:

CNP is required to implement food/beverage substitutions or modifications for students with disabilities

Substitutions or modifications for students with disabilities must be based on a prescription written by a licensed physician

CNP is encouraged, but not required, to provide dietary accommodations to students without disabilities

Substitutions for students without a disability still must be based on a statement by a recognized medical authority

CNP can not revise, change, and/or interpret a diet prescription or medical order


CNP’s Responsibilities Department Responsibilities Include:

Recommend USDA guidance, Accommodating Children with Special Dietary Needs

Document, Document, Document – to protect the school and minimize misunderstandings

Must maintain copies of these diets and documentation on file

Diet orders do not need to be renewed annually, however schools are encourage to ensure that the diet orders reflect the current dietary needs of the child


Children with Disabilities Considerations when providing meals to children with

disabilities

If a child’s IEP includes a nutrition component, the CNP should be involved early one in decisions regarding dietary accommodations

CNP is not required to provide a meal service to a student with disabilities when the meal service is not normally available to the general student body, unless that meal is required under the IEP


Children with Disabilities Two steps are required when serving meals to students with

disabilities

Prior to implementing any dietary accommodations, CNP must ensure the following was completed:

1. The parent/guardian must obtain a statement from the student’s physician and provide it to school officials. The statement must state the following:

a. the student’s disability; b. an explanation of why the disability restricts the student’s diet; c. the major life activity affected by the disability; and d. the food or foods to be omitted from the student’s diet and the food or choice of foods that must be substituted.


Children with Disabilities Two steps are required when serving meals to students with

disabilities

Prior to implementing any dietary accommodations, CNP must ensure the following was completed:

2. Evaluate the physician’s statement to see if it includes the required information above and meets Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA). Many schools refer to this simply as “504.” If the student’s physician statement does include the required information and the disability is included in these Acts, the school is not required, but encouraged to develop an Individualized Education Program (IEP) for the student or include the physician’s statement in the student’s existing IEP.


Texture Modifications Students with disabilities who require modifications in

texture, should provide written instructions from a licensed physician indicating, the appropriate food texture

To minimize misunderstandings, the CNP can apply stricter guidelines and require that the school keep on file these statements concerning modifications of food texture

CNP should maintain written instructions or guidance from a licensed physician regarding texture modifications (should be included in IEP)

CNP staff should follow these instructions that have been prescribed by the licensed physician


Additional Expenses Often students with disabilities can be accommodated

with little extra expense or involvement (OVS)

If additional expenses are incurred, the CE can absorb the cost of making meal modifications or paying for the services of a registered dietitian (hired consultant)

At no time can a school charge a student with a disability who requires food substitutions or modifications more than they charge other students for program meals or snacks


Additional Expenses If CNP has difficulty covering additional costs, the CE’s

general fund may used

Any additional funding received by the CNP for costs incurred in providing special meals must accrue to the non-profit CNP account


Legal Concerns & Liabilities Federal Law

Federal Law intends that students with disabilities have the same rights & privileges, access to benefits, such as school meals, as students without disabilities

If CNP does not make program accommodations for students with disabilities, they could be found in violation of federal civil rights laws

Section 504 Rehabilitation Act of 1973

Individuals with Disabilities Education Act (IDEA)

Title II Americans with Disabilities Act (ADA)


Legal Concerns & Liabilities Personal Responsibility in Case of Negligence

School & CNP need to determine if both the facilities and personnel are adequate to provide the requested service

In some circumstances, CNP may need to advise specially trained personnel, such as a registered dietitian to provide guidance

There may be unique situations and/or conditions where it is more appropriate for a nurse or trained health professional to feed the student

Speech therapist, Occupation therapist, Special Education teacher can be instrumental in assisting students develop & improve their eating habits


Legal Concerns & Liabilities Administered Feedings

When a student requires assistance with feeding, the determination of who will provide that service is a local decision

CNP is responsible for providing the foods needed by the student with a disability but it is NOT the specific responsibility of CNP to physically feed that student

A district should be aware of the liability that could result if a person or staff member with insufficient training were to perform these tasks or activities


Legal Concerns & Liabilities Diet Orders

If CNP staff have questions regarding a diet order, they should consult the student’s physician and/or registered dietitian who prescribed the diet order

Note Food Service Employees

Under no circumstances should CNP staff diagnose, perform nutritional assessment, prescribe or interpret, revise, or change a diet order


Situation and Responses

Special Diet Examples Meals and/or foods outside the meal service

Special needs that may or may not involve disabilities

Responsibilities of food service management companies and other CNP operations

Feeding in separate facilities – generally not acceptable

Temporary Disabilities

Complicated Feedings

SNP Account

Documentation


Situation 1 Meals and/or Foods Outside of the Normal Meal Service

Situation 1

As part of the therapy for a student with a disability, the licensed physician has required the student 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 periods. Is the SNP department required to provide all of the servings of juice?


Situation 1 Meals and/or Foods Outside of the Normal Meal Service Response 1

No. The general guideline in making accommodations is that students with disabilities must be able to participate in and receive benefits from programs that are available to children without disabilities.

In this example, the SNP department would be required to provide (and pay for) cranberry juice as part of the regular reimbursable breakfast, lunch and/or snack service. However, the SNP department would not be required to pay for other servings throughout the school day unless specified in the IEP.

It must be recognized that there will be exceptions to this general rule. For example, RCCIs, such as juvenile correction facilities, may be required to provide additional foods or servings since the student would have no other recourse for meals. It must be stressed that such accommodation would depend on the specific circumstances of each case and, in any event, would go beyond obligations under the SNP.

In general, additional servings beyond what is required under the program meal may, but need not, be charged to the nonprofit SNP account.



Situation 2

A student with a disability must have a full breakfast each morning. Is the SNP department required to provide a breakfast for this student even though a breakfast program is not available for the general school population?



Response 2

As noted above, the SNP department is not required to provide services and meals to students with disabilities that are not otherwise available to students who are not disabled. If the school does not have a breakfast program already, it does not need to initiate a program exclusively for students with disabilities.

However, if the IEP requires that a student receive a breakfast at school, the school must provide the service and may choose to have the SNP department handle the responsibility.



Situation 3

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?



Response 3

Yes. The school must provide the student food portions that exceed the minimum quantity requirements if specifically prescribed in the licensed physician’s statement.


Situation 4 Special Needs Which May or May Not Involve

Disabilities

Situation 4

A student has a life threatening allergy that 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 SNP department go to accommodate the child? Is it sufficient for the SNP department to merely avoid obvious foods, such as peanut butter, or must SNP staff research every ingredient and additive in processed foods or regularly post all of the ingredients used in recipes?


Situation 4 Special Needs Which May or May Not Involve Disabilities Response 4

The school has the responsibility to provide a safe, non-allergic meal to the student if it is determined that the condition is disabling. To do so, SNP department staff must make sure that all food items offered to the allergic student meet prescribed guidelines and are free of foods that are suspected of causing the allergic reaction.

This means that the food labels or specifications will need to be checked to ensure they do not contain traces of such substances. In some cases, the labels will provide enough information to make a reasonable judgment possible. If they do not provide enough information, it is the responsibility of the SNP department to obtain the necessary information to ensure that no allergic substances are present in the foods served.


Situation 4 Special Needs Which May or May Not Involve Disabilities Response 4

In some cases, it may be necessary to contact the supplier or the manufacturer. Private organizations, such as the Food Allergy and Anaphylaxis Network, may also be consulted for information and advice. The Food Allergy and Anaphylaxis Network can be contacted at 1-800-929-4040 or www.foodallergy.org. It is also wise to check with parents about certain foods and even provide them with advance copies of menus.

The general rule in these situations is to exercise caution at all times. Do not serve foods to students at risk for anaphylactic reactions if you do not know what is in those foods. It is important to recognize that a student may be provided a meal, which is equivalent to the meal served to other students, but not necessarily the same meal.

Sometimes, it will be advisable to prepare a separate meal “from scratch” using ingredients that are allowed on the special diet rather than serving a meal using processed foods.



Disabilities

Situation 5

A student has a health condition that does not meet the definition of “disability” set forth in the legislation and regulations. For example, the student is overweight (but not “morbidly” so) or the student has elevated blood cholesterol. Is the school obligated to accommodate the special dietary needs of this student?



Disabilities

Situation 6

A student’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?


Situation 9 Feeding in Separate Facilities – Generally Not

Acceptable

Situation 9

A school wishes to serve meals to students with disabilities in an area separate from the cafeteria where the majority of school’s students eat. May the school establish a separate facility for these students?


Situation 9 Feeding in Separate Facilities – Generally Not Acceptable Response 9

Federal civil rights legislation, including Section 504 of the Rehabilitation Act of 1973, IDEA and Title II of the ADA, requires that in providing for or arranging for the provision of nonacademic services and extracurricular activities, including meals, CEs must ensure that students with disabilities participate along with children without disabilities to the maximum extent appropriate to the needs of students with disabilities.

In general, students with disabilities must be allowed to participate with other students to the maximum extent appropriate. In this way, the student has the opportunity to interact with and learn from students without disabilities. The school must not segregate students with disabilities on the basis of convenience to the school or to other students.


Situation 9 Feeding in Separate Facilities – Generally Not Acceptable Response 9

In rare instances, however, it may be to a student’s benefit to be served separately. For instance, a student with severe motor disabilities may be able to receive individualized attention in handling eating utensils if a special education specialist is able to work with them outside the cafeteria.

Nevertheless, it must be emphasized that in all cases, the decision to feed students with disabilities separately must always be based on what is appropriate to meet the needs of the students. Schools cannot segregate students with disabilities based on the convenience of the school or other students.


Situation 10 Temporary Disabilities

Situation 10

A student was involved in an accident and underwent major oral surgery. As a result, the student 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 student will not be permanently disabled?


Situation 10 Temporary Disabilities

Response 10

A student’s whose disability restricts their diet must be provided substitutions or modifications to foods regardless of the duration of the disability.


Situation 11 Complicated Feedings

Situation 11

A student enrolled in the school will require tube feedings. Is the SNP department 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 SNP department?


Situation 11 Complicated Feedings Response 11

It must be emphasized that the overall responsibility for accommodating students with disabilities rests with the CE. The CE’s administration is responsible for allocating the CE’s costs of accommodating students with disabilities and for deciding which personnel will work with individual students.

In most instances involving food substitutions, the SNP account will be used to pay the cost of special food and food preparation equipment, and foodservice personnel will generally be responsible for providing the alternate meal. For example, if a student must have a pureed meal, it is reasonable to expect the SNP department to purchase a blender or food processor and to have the meal prepared by the SNP department staff.


Situation 11 Complicated Feedings Response 11

In the case of more delicate operations, such as tube feeding, it is advisable that commercial nutritive formulas, prescribed by a licensed physician and specially designed for tube feedings, be used rather than a school blenderized formula, which may be subject to spoilage and may not always have the correct consistency or nutritive content. Proper administration of this type of feeding generally requires the skills of specially trained personnel, such as nurses or the special trained aides who regularly work with the students.

Special labor costs may be covered through special education funds if the student has an IEP. If the student does not have an IEP, these costs may, as appropriate, be charged in part to the SNP nonprofit food service account or may be assigned to the CE’s general fund or to other funding sources.



Situation 12

A student 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 the SNP department make substitutions on an “as necessary” basis?



Response 12

No. SNP department staff cannot decide what substitutions are appropriate for a given student. SNP department staff should not choose the substitutions themselves because a student may be on a specific medication, which could interact in a negative way with a particular food item. Ideally, a list of appropriate substitutions should accompany the menus and the foods should be on hand on a regular basis. If such a list is not available, SNP department staff must ask parents to obtain from the student’s physician (or the individual who planned the student’s menus) a list of those foods that may be substituted.


Situation 13 Child Nutrition Account

Situation 13

A student with a disability needs to consume six cans of a nutritional supplement during the school day: two cans at breakfast, one can as a midmorning snack, two cans at lunch and one can as a mid-afternoon snack. The cost of the breakfast and lunch supplements is allowable SNP 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 SNP account?



Response 13

Yes. While it is not required that these costs be charged to the SNP account, these supplements are a legitimate charge to the SNP account.



Situation 14

A student with a disability requires the services of the school nurse for assistance in feeding at lunch. Can the SNP account be billed for the services of non-SNP department personnel, such as the school nurse or special aide who may be assisting in the feeding of the student or other nutrition-related activity?



Response 14

Yes. The services of any personnel necessary to the SNP department can be paid by the SNP account on a pro rata basis. It must be emphasized, however, that the SNP account may only pay for the amount of time that the person actually spends on activities related to the SNP. If a school nurse spends one hour per day feeding a student with a special need, then only that portion of his/her salary can be charged to the SNP account, not the entire salary. If the student is receiving special education and the child’s IEP includes a nutrition or feeding component, special education funds may be available to the school to provide required services for the student.


Situation 15 Documentation

Situation 15

The physician’s statement only specifies the medical disability not the required food substitutions. What should the SNP director do?


Situation 15 Documentation Response 15

An appropriate school official (such as the SNP director, SNP manager or school nurse) must ask parents to obtain more written information from the physician concerning the substitutions or modifications the student requires. If difficulties arise in obtaining the needed information, the parent(s) should be advised of the problem and asked to work with the school to obtain a complete medical statement for the student. It is important that the family understand that the school is unable to provide food substitutions or modifications without an adequate diet order or diet prescription.

In some cases, it may be appropriate and helpful for the physician to provide a written referral to a registered dietitian or other qualified professional for diet substitutions. For further guidance or referral to a registered dietitian, SNP directors may contact TDA.



Figure 1 Eating & Feeding Evaluation: Children with Special Needs


Student Legal Name



Must document the major life activities affected by the disability





Strategies & Key Food Safety Reminders HACCP, Standard Operating Procedures

Avoiding Cross Contamination Hand washing, Glove Changing Do you have procedures for BIC? Reviewing Food Labels

Chart Audits

Campus Audits

Training

Best Practices

Communication is key

Food Allergies & USDA Foods


Resources Accommodating Children with Special Dietary Needs

in School Nutrition Programs (USDA)

http://www.fns.usda.gov/sites/default/files/special_dietary_needs.pdf

Accommodating Children With Special Dietary Needs (TDA)

http://squaremeals.org/Portals/8/files/ARM/Section%2013-Accommodating%20Children%20with%20Special%20Dietary%20Needs.pdf


Resources

http://healthymeals.nal.usda.gov/resource-library/food-allergies/resources-schools#overlay-context=school-guidelines-managing-students-food-allergies

http://healthymeals.nal.usda.gov/resource-library/food-allergies/resources-schools

Resources

http://www.nfsmi.org/ResourceOverview.aspx?ID=452

Resources

http://www.neahin.org/assets/pdfs/foodallergybook_english.pdf

The End Result Despite the challenges and frustrations, remember the

ultimate goal!

Questions


Thank You


Technical Assistance Carmen Ocanas-Lerma,

Food & Nutrition Program Director

(956) [email protected]

Kimberly KellerFood & Nutrition

Specialist(956) 984-6121

[email protected]

Iris PerezFood & Nutrition

Specialist (956) [email protected]

Gilberto RequenaFood & Nutrition

Specialist(956) 984-6108

[email protected]

Erika LealFood & Nutrition

Program Technician(956) [email protected]

Sandra BazanFood & Nutrition

Program Technician(956) 984-6120

[email protected]


“This service (or product) is provided through the Texas Department

of Agriculture's school nutrition education, and outreach program

funded by the U. S. Department of Agriculture, Food and Nutrition

Service. In accordance with Federal Law and U.S. Department of

Agriculture policy, this institution is prohibited from discriminating on

the basis of race, color, national origin, sex, age, or disability. To file

a complaint of discrimination, write USDA, Director, Office of

Adjudication, 1400 Independence Avenue, SW, Washington, D.C.

20250-9410 or call toll free (866) 632-9992 (Voice). Individuals who

are hearing impaired or have speech disabilities may contact USDA

through the Federal Relay Service at (800) 877-8339; or (800) 845-

6136 (Spanish). USDA is an equal opportunity provider and employer” (USDA, 2011).


Documents

Region One FNP Kimberly Keller 1/21/15 · Strategies, Best Practices, & Key Reminders Question & Answers Helpful Resources Review of Case Studies ... Note: Lactose free milk is NOT