www.diabetes.org 1-800-DIABETES

SAFE AT SCHOOL: HOW POLICY CHANGE ENHANCES THE MEDICAL SAFETY AND

ACCESS TO EQUAL OPPORTUNITY IN EDUCATION

Crystal C. Jackson, Associate DirectorLegal Advocacy, ADA

CDC Diabetes Translation Conference 2008Orlando, FL

www.diabetes.org 1-800-DIABETES

TO PREVENT AND CURE DIABETES

AND TO IMPROVE THE LIVES OF ALL

PEOPLE AFFECTED BY DIABETES

ADA MISSION

www.diabetes.org 1-800-DIABETES

School & Diabetes• Diabetes care is 24/7• Child with diabetes cannot take a break• Smooth transition from home to school • Access to equipment, medication, and

assistance is essential• Development of written care plans

www.diabetes.org 1-800-DIABETES

Why is care at school important?

• To prevent short-term complications such as hypoglycemia

• To prevent or delay long-term complications such as heart and kidney disease and blindness

• To ensure that child has the best possible opportunity achieve academic success and safely participate and benefit from all school activities

www.diabetes.org 1-800-DIABETES

Goals of School Diabetes Care• A medically safe

environment for students with diabetes.

• Equal access to educational opportunities and school-related activities.

• Enable academic achievement and enhance quality of life.

www.diabetes.org 1-800-DIABETES

Legal Protections

• Section 504 of the Rehabilitation Act of 1973 (Section 504)

• Americans with Disabilities Act (ADA)

• Individuals with Disabilities Education Act (IDEA)

• State law and regulations

www.diabetes.org 1-800-DIABETES

Common Barriers to Care Despite Legal Protections

• Failure to have trained staff to assist students • School’s lack of knowledge about diabetes• Refusal to administer insulin and glucagon• Lack of coverage during field trips and

extracurricular activities• Refusal to allow self-management where the

student is• Refusing to enroll child or sending child to

“diabetes school”

www.diabetes.org 1-800-DIABETES

School Concerns• Blood glucose testing

– In the clinic– In the classroom

• Insulin administration– Supervision: nurse vs.

student vs. school personnel– Location

• In the clinic• In the classroom• Other

www.diabetes.org 1-800-DIABETES

Reality Check• School nurse not available at all places at all

times.• Reality is that most schools do not have a full-

time school nurse.• Even a full-time school nurse does not solve the

whole problem.• ADA supports a safe model that utilizes trained

school personnel in the absence of a school nurse.

www.diabetes.org 1-800-DIABETES

All school staff members need to have a basic knowledge of diabetes and know who to contact for help.

SAFE AT SCHOOL CAMPAIGN PRINCIPLES

Students should be permitted to provide self-care wherever they are at school or school-related activities.

What IsDiabetes

School nurse is primary provider of diabetes care, but other school personnel must be trained to perform diabetes care tasks when the school nurse is not present.

www.diabetes.org 1-800-DIABETES

American Academy of PediatricsAmerican Association of Clinical EndocrinologistsAmerican Association of Diabetes EducatorsAmerican Diabetes AssociationAmerican Dietetic AssociationChildren with DiabetesDisability Rights Education and Defense FundJuvenile Diabetes Research FoundationLawson Wilkins Pediatric Endocrine SocietyPediatric Endocrinology Nursing Society

SAFE AT SCHOOL PRINCIPLES ENDORSED BY:

www.diabetes.org 1-800-DIABETES

SAS AND ADA APPROACH

• Educate school personnel about diabetes and legal obligations.

• Negotiate using resources such as NDEP guide, Florida guidelines.

• Litigate if necessary – OCR, due process, courts

• Legislate if all else fails and clear legal barriers exist.

www.diabetes.org 1-800-DIABETES

SAFE AT SCHOOL EFFORTS RESULTING

IN POLICY CHANGE• School diabetes care legislation passed in 17

states.• U.S. Department of Justice settlement with two

major day care providers.• U.S. Department of Education agreements

resulting in improved standards of care for students with diabetes.

• Lawsuit settlement with California Department of Education (federal law vs. state law)

www.diabetes.org 1-800-DIABETES

School diabetes care laws enacted in 18 states

School diabetes care law legislation active in 5 states

LEGISLATE

Consider changing state law or policies if current laws and policies do not provide students with diabetes the protection they need

www.diabetes.org 1-800-DIABETES

Arizona

Connecticut

North Carolina

Kentucky

West Virginia

Virginia

Board of Nursing Action:

Nevada

Colorado

SCHOOL DIABETES CARE LAWSHawaii

Montana

Washington

Oregon

California

Oklahoma

South Carolina

Tennessee

Texas

Nebraska

Utah

Indiana

www.diabetes.org 1-800-DIABETES

School Diabetes Legislation Pending in:

Massachusetts

New Jersey

Rhode Island

“Advocate for children with diabetes at local, state and national levels.”

Sign up at the ADA Action Center: www.diabetes.org/advocacy

Pennsylvania

Illinois

www.diabetes.org 1-800-DIABETES

Litigate• File complaint with U.S. Department of Education,

Office of Civil Rights.

• School district or state due process/grievance procedure/hearing.

• File complaint in state court.

• File complaint in federal court.

www.diabetes.org 1-800-DIABETES

CDE Lawsuit Settlement• California Department of Education Legal

Advisory• Permits non-medical school employees to

administer insulin when a nurse is not available• California school districts must meet

requirements of federal law – even if nurse is not available

• Prohibits sending students to a particular school as a condition of receiving medication and care

www.diabetes.org 1-800-DIABETES

But not all policy change involves a fight…..

www.diabetes.org 1-800-DIABETES

Examples of Collaboration Resulting in Policy Change

• Colorado School Diabetes Resource Nurse Model

• Colorado Board of Nursing Rule Change• Utah Glucagon Legislation• Proposed Utah Board of Nursing Rule

Change

www.diabetes.org 1-800-DIABETES

Safety + Access = Success!!!