Accommodating Special Diets The Team Approach CSNA Summer Conference Wednesday June 12 2018 1 pm 2 pm Together We Can Colorado Department of Education Vision All students in Colorado will become educated and productive citizens capable of succeeding in society the workforce and life ID: 771954
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Accommodating Special Diets: The Team Approach CSNA Summer Conference Wednesday, June 12, 2018 1 p.m. – 2 p.m.
Together We Can Colorado Department of Education Vision All students in Colorado will become educated and productive citizens capable of succeeding in society, the workforce, and life. CDE Office of School Nutrition Mission The Office of School Nutrition is committed to ensuring all school-aged children have equal access to healthy meals by supporting, training, and connecting Colorado’s child nutrition community.
Objectives Understand special meal accommodations regulations Identify best practices in working parents and school nurses in accommodating special dietary needs
Introduction to Special Meal Accommodations Kristi Rolfsen, MS, RD Nutrition Programs Senior Consultant CDE Office of School Nutrition
Background ADA Amendments Act of 2008 Simplified the question of whether a child has a disability USDA Memo SP 59-2016 Definition of a disability expanded Almost all medical needs require an accommodation Medical statements are not required if request falls within meal pattern Utilization of team approach
Examples of Disabilities Food allergies Food intolerances Autism and/or other mental impairments Phenylketonuria Diabetes Celiac Disease Obesity “Categories and conditions” in the ADA is not all inclusive.
Meal Modifications SFAs must have a policy in place to accommodate special dietary needs Reimbursement based on child’s eligibility Additional costs may be paid from the nonprofit food service account
Meal Modifications within the Meal Pattern Do not require a medical statement Strongly encouraged to have a Dietary Preference Form or other documentation Should note actions to accommodate the child’s disability Safeguards the child SFAs may choose to require a medical statement for modifications within the meal pattern
Meal Modifications Outside the Meal Pattern Medical statement signed by a licensed healthcare professional is required Medical statement must include: Information on the child’s disability and dietary restrictions Explanation of dietary modifications Food(s) or beverage(s) to be omitted and substituted If information is written into IEP or 504 plan, a medical statement is not required
Dietary Preferences Modifications for dietary preferences are not required General health concerns (i.e. preference for gluten-free diet) Cultural, religious and ethical preferences Modifications must be within the meal pattern Dietary Preference Form is encouraged
Reasonable Modifications A change or alteration in policies, practices, and/or procedures in order to accommodate Must be related to disabling condition Must be made on a case-by-case basis
Reasonable Modifications- Things to Consider Food Allergies Offer vs. Serve Portion Sizes Brand Name Requests Tracking Dietary Intake Fluid Milk Substitutions
The Team Approach A team approach should be used for meal modifications The 504 coordinator is responsible for addressing disability requests LEAs are encouraged to develop a team SFAs are encouraged to work with school nurses and parents
Accommodating Special Diets: Building Relationships and Working with Parents Becky Wiggins, RD Nutrition Coordinator Poudre School District
Overview Step by Step Process Conference Meetings Special Menus Maintaining relationship Benefits Good and Bad Examples
Step by Step Process – Step #1 The Phone Call Create a rapport with the family Gain a clear understanding of the foods needing to be omitted and substitution options Provide clear instructions on how student’s meal modification needs will be met
Step by Step Process – Step #2 Allergy Pop-Up & Kitchen Communication Meal modification forms are sent to the kitchen Communicate meal modification information to the kitchen manager Pop-up allergy alert is added in the student’s meal account Cashiers are provided with lists of foods containing the top 8 food allergies as a quick reference
Quick Reference Food Allergy Lists PEANUT/ TREE NUT Honey Nut Cheerios Cereal (Tree Nuts) Uncrustable Peanut Butter and Jelly Sandwich (Peanuts) Grape and Strawberry May Contain: Breakfast Rounds (Peanuts, Tree Nuts) Chocolate Chip Original (Cinnamon) Chili Seasoning (Tree Nuts) Chocolate Chip Cookies (Peanuts and Tree Nuts) Hamburger Bun (Tree Nuts) Sugar Cookies (Peanuts and Tree Nuts) Cocoa Cherry Bar (Tree Nuts) Garlic Powder (Tree Nuts) Ginger Spice (Tree Nuts) Yogurt Chips (Tree Nuts )
Step by Step Process – Step #3 Conference Meeting Offer conference meeting to all families Provides opportunity to get all parties on the same page and create a relationship
Conference Meeting Parents Student, if age appropriate Nutrition Coordinator Kitchen manager and kitchen staff Child Nutrition Area Supervisor School Nurse
Step by Step Process – Step #4 Special Menus We have found that in most cases it is easier for the kitchens and the families if I create a special menu for students in need of meal modifications
Special Menus Special gluten free, dairy free, allergen free menus are created for the kitchens to follow, based on family/student preferences Monthly the special menus are sent to the parents We request that they let the kitchen manager know what days their students will eat, so we can provide the proper meals
Special Menus
Maintaining Relationships Special menus are sent monthly to parents This also provides an opportunity to touch base with them and ensure everything is still going smoothly Additional conference meetings are offered, whenever changes occur Menu cycle change Kitchen Manager change Student changes school
Benefits of Building Relationships Allows us to control substitution requests Helps financially Provides clear instructions on how best to accommodate student Eliminates stress for kitchens Satisfied parents Allows parents to have an understanding of realistic requests for our department
Before Relationship Building – Example Medical statement received for gluten and dairy substitutes Restricted all gluten and dairy items & provided recommended substitute Parent called kitchen manager with unreasonable requests Requests were difficult for kitchen manager to manage No relationship = chaos
After Relationship Building - Example Student with sensory eating disorder, dysphagia, and dairy allergy Immediately called parent to schedule conference meeting Met with mom, nurse, kitchen manager and staff, area supervisor and myself Parent provided clear instructions on how to prepare his foods and what foods he would accept Within 2 weeks, he started accepting new foods- which he unsuccessfully had done for years with eating therapy centers!
Accommodating Special Diets: Collaborating with Nursing Services Amy Faricy , RD Manager of Menu Services Douglas County School District
History of Accommodating Special Diets in DCSD
Types of Meal Modifications
Communication Gaps
Benefits of Collaborating with Nursing Team Shared purpose Established point of contact Share knowledge and ideas Build rapport Improved customer service Training opportunities Increase in meal modifications provided
How to Start the Collaboration Process Outline your objectives Identify collaborators Be prepared Schedule brainstorming time Communicate and follow up
Questions?
Resources CDE OSN Special Dietary Needs webpage Special Dietary Needs Online Training Documentation Flowchart Milk Substitution Flowchart SOP Template Medical Statement & Preference Form (English & Spanish) Discontinuation Form Letter to Parents Template USDA’s Accommodating Children with Disabilities in the School Meal Programs: Guidance for School Food Service Professionals