Accommodating Special Dietary Needs Jenny Fuller KDE

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    16-Dec-2015

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<ul><li> Slide 1 </li> <li> Accommodating Special Dietary Needs Jenny Fuller KDE </li> <li> Slide 2 </li> <li> USDA Regulations - Disability Require substitutions or modifications in meals for children who are considered disabled 504 IDEA Certified by a licensed physician Regulations - Disability </li> <li> Slide 3 </li> <li> Definition of Disability According to Section 504, a person with a disability means any person who: 1. Has a physical or mental impairment that substantially limits one or more major life activities 2. Has a record of such an impairment 3. Is regarded as having such an impairment Definition of Disability </li> <li> Slide 4 </li> <li> Definition of a Disability According to IDEA, a person with a disability means 1. Having one or more of the recognized disability categories 2. Disability adversely affects educational performance 3. Child needs special education and related services Definition of Disability </li> <li> Slide 5 </li> <li> Major Life Activities Include: Caring for ones self Performing manual tasks Walking Seeing Hearing Speaking Breathing Learning Working Sleeping Eating Standing Lifting Bending Reading Concentrating Thinking Communicating Major Life Activities </li> <li> Slide 6 </li> <li> Modifications for Children with Dietary Disabilities Require substitutions and/or modifications for children whose disability restricts their diet Documentation from a licensed physician Health history from school nurse is not acceptable Documentation must identify: The childs disability An explanation of why the disability restricts the childs diet The major life activity affected by the disability The food or foods to be omitted from the childs diet and the food or choice of foods that must be substituted Modifications </li> <li> Slide 7 </li> <li> Medical Statement - Disabilities Must be completed in its entirety Provided before school food service can make any meal modifications Ensures that the modified meal is reimbursable and meets nutrition standards Can use same record from year to year if nothing has changed Medical Statement </li> <li> Slide 8 </li> <li> Scenarios SCENARIO 1 A students mother brought in a medical statement signed by a licensed physician certifying a dietary disability. The medical statement is unclear and school food service in not sure they can provide the requested accommodations. What should the school do? Scenarios </li> <li> Slide 9 </li> <li> SCENARIO 1 ANSWER: If school food service feels the medical statement is unclear or is an undue burden, then they are encouraged to convene a meeting including appropriate personnel such as: food service staff, administration, parents, school nursing staff and the physician to clarify the medical statement and determine appropriate accommodations for the student. Scenarios </li> <li> Slide 10 </li> <li> SCENARIO 2 A licensed physicians statement only specifies the medical disability, not the required food substitutions. Can the school food service staff decide what food should be substituted? Scenarios </li> <li> Slide 11 </li> <li> SCENARIO 2 Answer No! An appropriate school official must receive parent or guardian permission to obtain more information from the licensed physician concerning substitutions or modifications the student requires. Scenarios </li> <li> Slide 12 </li> <li> SCENARIO 3 A child in your school has a documented life threatening food allergy that causes an anaphylactic reaction to peanuts. The mother requests that food service staff read all food labels for peanut ingredients to ensure a safe meal for her child. Does the food service need to accommodate this request? Scenarios </li> <li> Slide 13 </li> <li> SCENARIO 3 ANSWER YES! A life threatening food allergy that causes an anaphylactic reaction is considered a dietary disability because it can affect a major life activity, breathing. Therefore, accommodations are mandated. The request for reading food labels should be included in the medical statement signed by the licensed physician. Scenarios </li> <li> Slide 14 </li> <li> Temporary Disabilities Must accommodate disabilities regardless of duration Example: A child who had major oral surgery Temporary Disability </li> <li> Slide 15 </li> <li> Texture Modifications Meals modified for texture will consist of regular school menu items Unless specified by licensed physician Texture Modification </li> <li> Slide 16 </li> <li> Specific Brands Not required to provide a specific brand Provide only the medically appropriate substitutions specified in medical statement Specific Brands </li> <li> Slide 17 </li> <li> Different Portion Sizes Must provide specified portions Prescribed by licensed physician Portion Sizes </li> <li> Slide 18 </li> <li> A La Carte Foods &amp; Beverages Required accommodations only apply to reimbursable meals If items included in IEP, school district must provide them; may have food service handle this responsibility A La Carte </li> <li> Slide 19 </li> <li> Meal Services Outside of USDA Meal Programs Not required to provide meals when meal service is not available for general student body Unless Child has IEP that requires a meal Child resides in a residential child care institution (RCCI) Meals Outside USDA Meal Programs </li> <li> Slide 20 </li> <li> Carbohydrate Counts Responsible for providing carbohydrate count to family for each food item served in one daily meal choice NOT responsible for weighing or measuring food, or determining proper amount of carbohydrates needed or consumed Responsibility of school nurse or other designated medical personnel Carbohydrate Counts </li> <li> Slide 21 </li> <li> Appropriate Eating Areas Ensure that students with disabilities participate with nondisabled students to the maximum extent appropriate Some instances, may be to childs benefit to be served separately All decisions must be based on what is appropriate to meet the needs of the child Eating Areas </li> <li> Slide 22 </li> <li> Dietary Disability Recap Distinction between definition of disability for Section 504 &amp; IDEA and for the purpose of food modifications/substitutions Modifications may include: Food restrictions Carbohydrate counts Texture changes Increased or decreased calories Medical statement must be signed by a licensed physician and kept on file Modifications for a Disability &amp; documentation do not have to meet the meal pattern Recap - Disability </li> <li> Slide 23 </li> <li> Scenarios SCENARIO 1 A student with celiac disease has a medical statement signed by a licensed physician that prescribes a gluten-free diet. Does the school food service need to accommodate this request? Scenarios </li> <li> Slide 24 </li> <li> SCENARIO 1 ANSWER YES! The students physician has determined that the medical condition affects a major life activity and rises to the level of a disability. Therefore, school food service must accommodate the physicians diet prescription. Scenarios </li> <li> Slide 25 </li> <li> SCENARIO 2 Occupational therapy staff is requesting that a disabled student eat their meals outside the cafeteria in order to work on feeding skills. Is this acceptable? Scenarios </li> <li> Slide 26 </li> <li> SCENARIO 2 ANSWER Federal civil rights legislation requires that in providing for or arranging for the provision of nonacademic services and extracurricular activities, including meals, school districts must ensure that students with disabilities participate with nondisabled students to the maximum extent appropriate to the needs of students with disabilities. In rare instances, however, it may be to a childs benefit to be served separately. Scenarios </li> <li> Slide 27 </li> <li> SCENARIO 2 contd For instance, a child with severe motor disabilities may be able to receive individualized attention in handling eating utensils if a special education staff member is able to work with the student outside the cafeteria. In all cases, the decision to feed disabled children must always be based on what is appropriate to meet the needs of the children. Scenarios </li> <li> Slide 28 </li> <li> SCENARIO 3 A student has type 1 diabetes. The Individual Education Plan states that carbohydrate counting will be used as part of the medical treatment. Is food service staff required to count the carbohydrates this student eats? Scenarios </li> <li> Slide 29 </li> <li> SCENARIO 3 ANSWER The school district is responsible for providing a carbohydrate count to the family of a diabetic child for each food item served in one daily reimbursable meal choice. Food service personnel are not responsible for weighing or measuring leftover food or determining the proper amount of carbohydrates needed or consumed. This is the responsibility of the school nurse or other designated medical personnel if requested. Scenarios </li> <li> Slide 30 </li> <li> USDA Regulations Non Disability Permit substitutions or modifications in meals for children without dietary disabilities, but with medical or other special dietary needs School may choose to make these accommodations Regulations </li> <li> Slide 31 </li> <li> Modifications for Children Without Disabilities Schools encouraged, but not required to make modifications Documentation from a recognized medical authority Documentation must identify: Medical or other special dietary condition which restricts the childs diet The food or foods to be omitted from the childs diet The food or choice of foods to be substituted Modifications Without Disability </li> <li> Slide 32 </li> <li> Examples of Medical Conditions Food intolerance Food allergies (not affecting a major life activity) Elevated blood cholesterol Overweight (not morbidly obese) Medical Conditions </li> <li> Slide 33 </li> <li> Meal Modifications for Students Without a Disability Children without food allergies that do not affect a major life activity are not considered to have a dietary disability A meal that is modified must still meet the meal pattern requirements to be reimbursable Meal Modifications Without Disability </li> <li> Slide 34 </li> <li> Offer vs. Serve Allows students to decline a certain number off food items in the meal Can assist in accommodating students with special dietary needs Offer vs. Serve </li> <li> Slide 35 </li> <li> Scenarios SCENARIO 1 If the school food service does decide to make food substitutions and/or modifications for students without a dietary disability, what documents are required? Scenarios </li> <li> Slide 36 </li> <li> SCENARIO 1 Answer Each special dietary request must be supported by a statement, which explains the food substitution that is requested. It must be signed by a recognized medical authority. The medical statement must include: An identification of the medical or other dietary condition that restricts the childs diet, the food or foods to be omitted from the childs diet, and the food or choice of foods to be substituted. Scenarios </li> <li> Slide 37 </li> <li> SCENARIO 2 Are schools required to provide a modified meal to a child whose parents are strict vegetarians and want their child to be provided with vegetarian meals? Scenarios </li> <li> Slide 38 </li> <li> SCENARIO 2 ANSWER NO! A school food service is not required to make accommodations based on food preferences of a family or child. Scenarios </li> <li> Slide 39 </li> <li> Non-Disability Recap Schools have the option of providing accommodations Medical statement must be signed by a recognized medical authority and kept on file Offer vs. Serve may help to provide meal solutions to non-disability requests Recap Non-Disability </li> <li> Slide 40 </li> <li> Lactose-Free Milk Creditable as the milk component for meals Must be low-fat (1%) or fat-free (skim) May be substituted without written statement May not charge more Lactose-Free Milk </li> <li> Slide 41 </li> <li> Non Dairy Milk Substitutions May provide non dairy substitutes when requested by parent/guardian Must be nutritionally equivalent to fluid milk If make milk substitutions available, must be available for all children when request made At the expense of the school food service program Non Dairy Milk Substitutions </li> <li> Slide 42 </li> <li> USDA Nutritional Standards for Non Dairy Milk Substitutions Nutrients Per Cup (8 fluid ounces) Calcium: 276 mg Protein: 8 g Vitamin A: 500 IU Vitamin D: 100 IU Magnesium: 24 mg Phosphorus: 222 mg Potassium: 349 mg Riboflavin: 0.44 mg Vitamin B12: 1.1 mcg Non Dairy Milk Substitutions </li> <li> Slide 43 </li> <li> Summary of Allowable Milk Substitutions (non disability) ScenarioIs This a Reimbursable Meal? The school provides whole milk or reduced fat (2%) milk. No. The USDA requires that schools serve only low-fat (1%) or fat-free (skim) milk. The school provides lactose-free milk. Yes, if the lactose free milk is low fat (1%) or fat free (Skim). The school provides a nondairy milk substitute that does not meet the USDA nutrition standards. No. All nondairy milk must meet the USDA nutrition standards. The school provides juice or water instead of milk. No. Juice or milk can never be offered as milk substitutes. All substitutions must be either lactose-free milk or a nondairy beverage that meets the nutrition standards. Non Dairy Milk Substitutions </li> <li> Slide 44 </li> <li> Scenarios SCENARIO 1 When a student has a non-disabling milk allergy, can juice or water be substituted for milk? Scenarios </li> <li> Slide 45 </li> <li> SCENARIO 1 ANSWER No. Children with non-disabling milk allergies may only be offered a nondairy beverage that is nutritionally equivalent to fluid milk a specified by USDA. However, if the milk allergy is a dietary disability, a juice or water substitution prescribed by a licensed physician must be followed. Scenarios </li> <li> Slide 46 </li> <li> SCENARIO 2 If a student pays full price for their lunch, but has a request from a parent to provide lactose-free milk, is the school food service responsible for providing that accommodation? Scenarios </li> <li> Slide 47 </li> <li> SCENARIO 2 Answer The USDA requirements for accommodating special dietary needs apply to all children regardless of their eligibility for paid, free, or reduced-price meals. School food service is encouraged, but not required, to provide food substitutions or modifications for children without disabilities. Lactose-free milk is creditable as the milk component for reimbursable meals and can be provided without written request. Scenarios </li> <li> Slide 48 </li> <li> Requirements For All Special Dietary Accommodations Documentation Required to have documentation on file Regardless of disabled or nondisabled All changes to diet order must be in writing Food service personnel should never revise or change diet prescription Recommend schools develop a plan for ensuring current information on file Documentation </li> <li> Slide 49 </li> <li> Requirements For All Special Dietary Accommodations Price of Meals Cannot charge more for modified meals Accommodating special d...</li></ul>