Hi again,
If you are new to managing food allergies in schools you may be wondering about the terms "504 plan," "care plan," "individualized health plan," etc. Read on for a very long post about these topics.
Disclaimer: Please keep in mind that I am not a lawyer or a health care provider. I did participate in the development of the Washington State Guidelines for Care of Students with Anaphylaxis and I have managed my child's food allergy in public schools for 6 years. This post is intended to help you with your own research and provide possible topics to discuss with the appropriate licensed professionals when choosing and drafting your child's care plans for school.
Section 504 Plans and the Americans with Disabilities Act (ADA)
Luckily for all of us, there is an excellent explanation of Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act for public schools at Wrights Law webstie:
http://www.wrightslaw.com/info/section504.ada.peer.htmThere are also brief descriptions in the Washington State Anaphylaxis Guidelines under the heading State and Federal Laws:
http://www.k12.wa.us/HealthServices/Publications/09-0009.aspxThese laws establish that students with disabilities cannot experience discrimination because of their disability. These students have a right to "free and appropriate education" (FAPE). Public schools are local public institutions that receive federal funds; private schools who accept federal funds would also be required to meet these standards. Students with life-threatening food allergies (those in which the ability to eat, breath, study, etc., would be compromised if an exposure were to happen in the classroom) are protected by the ADA. The plan and process that spells out the accommodations that allow a school to accommodate a child with a disability is called a 504 Plan.
Wrights Law also has a page dedicated to explaining and distinguishing the differences between Section 504 and the Individuals with Disabilities Education Act (IDEA). The bottom line is that the needs of most students with life-threatening food allergies are addressed under Section 504.
While all students at risk for life-threatening anaphylaxis are protected by Section 504 and the ADA, a parent must go to the school district and request that their child be evaluated for the disability designation. Once the school has agreed to engage in the 504 process, there is a well defined set of criteria for creating the 504 plan and for requesting hearings if the plan is not being followed.
Rhonda Riggott Stevens, The Food Allergy Advocate, and the author of the Massachusetts guidelines, has a great website on Section 504 and how to develop a 504 plans for a food allergic student.
Individual Health Plan/Emergency Care Plan
An Individual Health Plan" (IHP) or nursing care plan are two terms used by public school nurses in the State of Washington to describe a health care management plan for a student. In 2002 in response to Nathan Walter's death on a field trip while he was enrolled in Spokane Public Schools, the state passed a law that required all students with life-threatening health conditions to have treatment and medication orders and a nursing care plan in place before the start of school (RCW 28A.210.320). (I provide links to examples of medication orders under Nuts and Bolts below). An emergency care plan (ECP) is a third type of plan, defined in the OSPI guidelines, that describes how to respond in the event of a food allergy emergency. Most parents of food allergic children have developed some sort of emergency care plan or use something like the Food Allergy Action Plan that is available from the Food Allergy and Anaphylaxis Network.
In the OSPI Anaphylaxis Guidelines (p. 11), OSPI offers this clarification:
"Emergency Care Plan and/or an Individualized Health Plan
Any student diagnosed with a life-threatening allergy must have an emergency care
plan (ECP). Most often the ECP is incorporated into a more comprehensive individual
health plan (IHP). An ECP may be separate or a part of the IHP. The ECP/IHP may also
be the 504 plan. In accordance with RCW 28A.210.320, the plans must be completed
prior to the student attending school. Care plans are developed by the school nurse in
collaboration with the family and a team of professionals, addressing the school's
overall responsibilities for the provision of a safe school environment. The ECP/IHP is
distributed to school staff having contact with the student. The school nurse trains and
supervises school staff regarding their responsibilities and care under the guidance of
the written care plan(s)."
The "team of professionals" could refer to anyone the parent or nurse deems to be critically important in the development of the ECP/IHP, which could be nutrition services, non-homeroom teachers, etc.
Similarities and Difference
The major difference between an ECP/IHP and a 504 Plan is in the process and level of compliance; content could theoretically be exactly the same. Your school district has a process in place for evaluating a student's need for a 504 Plan. Your job is to notify the district that you would like to have your child's situation evaluated. The district will also have a 504 Coordinator and your school will have a designated 504 officer who will be on your student's 504 team. Once it is determined that your child needs a 504 Plan, you would follow your districts 504 meeting process. Regarding compliance, the district would have an established mechanism for you to submit a complaint.
It could be argued that, because a 504 process ultimately engages more school staff in the development of a care plan, it is a better choice than an ECP/IHP. The more staff members who know about your child's situation, the better. From the school perspective, it is also a more cumbersome endeavor as it does require direct attention of the 504 Officer, who is often the school principal or other administrator. On the other hand, in a school where the level of food allergy awareness is high, EMP/IHP may be just as effective at achieving a safe environment for your child.
It is my understanding that a school could argue that, even though your child has a medical condition that entitles them to accommodations, the child does not need a 504 plan because the school is already accommodating your child with current policies, such as designating an allergen-free classroom or a peanut-/tree nut-free table. That said, based on my participation in the state anaphylaxis guidelines development, if a parent can show that a school is not providing a safe learning environment for their child or feels that the ECP/IHP process is not resulting in appropriate accommodations, it would be difficult for a district to deny that family's request for a 504 Plan. LIkewise, I think there are many situations for which a 504 is in definitely in order, such as the situation where a student who has multiple life-threatening food allergies or life-threatening allergies and asthma or a school environment exists which poses an increased risk to a food allergic individual, such as schools where lunch is eaten in the classroom.
Any parent of a student who has a life-threatening condition and who feels that their school is not accommodating them can file a complaint through the Office of Civil Rights (OCR), however, for some reason that I don't completely understand but most likely to avoid duplication of efforts, you cannot then file a complaint with the school. Here is the link to the Wright's Law page on this issue:
http://www.wrightslaw.com/info/sec504.faqs.ocr.complaints.htm.
The nuts and bolts
In practice, health plans - IHPs and 504 plans in particular - are often hammered out in the week before school, which can make for a stressful time for parents of food allergic students. The thought that you will be leaving your child in the care of adults who may or may not understand all they need to know about food allergies is daunting and extremely stressful. Preparation and good communication can go far to alleviate this stress and improve the likelihood that your child will be safe at school from day one because they will be in the care of staff members who are educated about their food allergy. Here are some tips to help you start the year with confidence.
Be Proactive! It is important to advocate for your child in the short time before summer ends and school starts. Nurses are only funded for a few days (I believe the number is 2 or 3) to prepare health plans. Make sure your school nurse and teacher have an email or voice mail from you requesting a meeting with you at their earliest convenience.
Be Prepared! If you don't have the required forms to give to your child's doctor, get your hands on them and fax or drop off at your doctor's office, the sooner the better. Draft letters that can be modified when you get more details from the teacher about what food allergy issues will need to be managed in your child's new classroom or school. Come up with a list of your concerns or requests so that you will be prepared for the meeting. It might help to share your list with the nurse and teacher before hand. Rhonda Riggott Stevens has a fairly comprehensive list of possible accommodations for food allergic students in school on her website (listed below). Food projects, field trips, snacks, and the teacher's plans on how to handle classroom celebrations, and where to store the epinephrine should definitely be on the list.
Be patient! Nurses are overloaded at this time of year and they work very hard to accommodate all students and you can feel fairly confident that the life-threatening nature of your child's food allergy will bring their plan to the top of the pile in most cases. Teachers are also busy but they will have a vested interest in getting to know you and learn about your child's food allergy.
Be Persistent! If the day before school has arrived and you haven't heard from the school nurse or teacher, then you need to get in there and figure out what is going on. One year, our school nurse got very sick and staff training did not happen when it was supposed to and did not figure this out until much later than the first day of school. If you are like me and really don't enjoy causing others undue hardship, keep in mind that they may not understand what is at stake - a child left in the care of adults who don't know they are at risk for anaphylaxis is a dangerous child. It is vitally important to make sure that information about your child's food allergy gets out to everyone you and the nurse deem worthy if not the entire staff.
Start planning for training! If it seems like your school could benefit from school food allergy training, start the process of scheduling a training session with a school food allergy educator or get your hands on a training module. See links below.
Links/Resources
Wrights Law resources: Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act
http://www.wrightslaw.com/info/section504.ada.peer.htmWashington State 2009: Guidelines for the Care of Students with Anaphylaxis
http://www.k12.wa.us/HealthServices/Publications/09-0009.aspxThe Food Allergy Advocate, Rhonda Riggott Stevents
http://www.foodallergyadvocate.com/504Plan.htmDifference between IDEA and 504
http://www.wrightslaw.com/advoc/articles/504_IDEA_Rosenfeld.htmlSeattle Public Schools 504 student evaluation form:
http://www.seattleschools.org/area/speced/documents/504form2.pdfSeattle Public Schools Medication Authorization:
http://www.seattleschools.org/area/healthservices/forms/medauth1.pdfSeattle Public Schools Health Registration Form (asks about life-threatening allergies and asthma):
http://www.seattleschools.org/area/healthservices/forms/healthreg4705.pdfSeattle Public Schools Mutual Exchange Form:
http://www.seattleschools.org/area/healthservices/forms/exchange.pdfFAAN's Food Allergy Action Plan
http://www.foodallergy.org/files/FAAP.pdfOCR Online Compaint Form
http://www2.ed.gov/about/offices/list/ocr/complaintintro.htmlSchool Food Allergy Training - Seattle Children's Food Allergy Community Health Educator - Hilary Stephens, RN - FREE TRAINING! Schedule soon!
http://www.seattlechildrens.org/classes-community/community-programs/food-allergy/ELL Foundation/Protect Allergic Children Safe at School training - Erin Hayes, Seattle consultant; fee
http://ellfoundation.org/protect-allergic-children/training-services/FAAN School Food Allergy Program including "Safe At School" Powerpoint - UPDATED!
School Food Allergy Program $75
Comprehensive Guide Only $40
Safe@School Only $40
Available for ordering from FAAN in October.
I hope this is helpful to some of you! And for those of you with law degrees or who have more experience with 504s than I do, please chime in!
Also, I will point out again that this information is not legal advice and I am only sharing my observations and interpretation of the laws and regulations. You should consult your lawyer for legal advice and your health care provider for help assessing the need for and the contents of your child's emergency care plan,individual care plan and/or 504 plan. Washington FEAST listserve disclaimers apply as well.
Kelly Morgan, President Washington FEAST,
www.wafeast.org
