Addressing Food Allergies in Schools
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ITS ALL ABOUT THE FOOD ALLERGY AND THEIR TREATMENT
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ADDRESSING FOOD ALLERGIES
IN SCHOOLS
[PRESENTER, TITLE]
[ORGANIZATION]
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Addressing Food Allergies in Schools
- 1. 1 ADDRESSING FOOD ALLERGIES IN SCHOOLS [PRESENTER, TITLE] [ORGANIZATION] [DATE]
- 2. 2 SESSION OBJECTIVES 1.Develop an awareness of food allergy basics 2.Learn why schools should address food allergies 3.Understand the components of food allergy policy 4.Learn about resources for policy and practice
- 3. 3 Food allergy is a potentially serious immune response to eating or otherwise coming into contact with certain foods or food additives. A food allergy occurs when the immune system: 1) identifies a food protein as dangerous and creates antibodies against it; and 2) tries to protect the body against the danger by releasing substances, such as histamine, tryptase, and others, into our blood when that food is eaten.
- 4. 4 FOOD ALLERGY VS. FOOD INTOLERANCE Food allergy is a potentially serious immune response to eating certain foods. Food Intolerance is an adverse reaction to food that does not involve the immune system and is not life-threatening. Example Lactose intolerance Trouble digesting milk sugar (lactose) Symptoms Might include abdominal cramps, bloating and diarrhea
- 5. 5 One or more symptoms: Can occur within minutes up to hours Can be mild to life-threatening Trouble swallowing Shortness of breath Repetitive coughing Voice change Nausea & vomiting Diarrhea Abdominal cramping Drop in blood pressure Loss of consciousness Swelling Hives Eczema Itchy red rash SYMPTOMS
- 6. 6 LIFE-THREATENING REACTION: ANAPHYLAXIS A serious allergic reaction that is rapid in onset and may cause death Food Insect Venom Medications Latex
- 7. 7 TREATMENT OF ANAPHYLAXIS • Epinephrine by injection is the treatment for a serious reaction • Quick administration is key – a delay can be deadly • Follow-up care and observation in the emergency room for 4-6 hours • Biphasic reactions occur about 20% of the time (symptoms improve or disappear, then the 2nd wave can be worse than the first)
- 8. 8 WHY SHOULD SCHOOLS BE PREPARED TO ADDRESS FOOD ALLERGIES? • Responsibility for health and safety of children at school • Food allergy is the most common cause of anaphylaxis. • Need for immediate response • Factor when dealing with other chronic conditions. • Unique social and emotional challenges
- 9. 9 WHY IS COMPREHENSIVE FOOD ALLERGY POLICY NEEDED? • Increased presence of students with food allergy; 18% increase (children under 18) 1997 – 2007 • All students need to be safe and ready to learn – Teens are the highest risk group for fatal allergic reactions • Emergencies are inevitable – Proactive approach rather than reactive
- 10. 10 LAWS AND LIABILITY • A life-threatening food allergy can be considered a disability under federal laws – Rehabilitation Act of 1973, Section 504 – The Individuals with Disabilities Education Act (IDEA) – The Americans with Disabilities Act (ADA), along with the ADA Amendments of 2008 (ADAA) • Assure compliance for privacy and confidentiality – Family Educational Rights and Privacy Act (FERPA) and – Health Insurance Portability and Accountability Act of 1996 (HIPAA) • Civil rights claim on behalf of student – Follow the laws or parents/caregivers can file a claim
- 11. 11 MANAGING FOOD ALLERGIES Shared responsibility among schools, students, families, and healthcare providers Avoidance of food allergens Being prepared in case of a reaction
- 12. 12
- 13. 13 AVOIDANCE OF KNOWN FOOD ALLERGENS Eight (8) foods cause ninety (90) percent of the food allergic reactions in the United States: Milk Peanuts Eggs Tree Nuts Wheat Fish Soy Shellfish
- 14. 14 REVIEW What Questions Come to Mind?
- 15. 15 Comprehensive Policy Guidance: Management of Life-Threatening Food Allergies in Schools
- 16. SAFE AT SCHOOL AND READY TO LEARN: 10 POLICY COMPONENTS 1. Identification of students with food allergies and provision of school health services 2. Individual written management plans 3. Medication protocols: storage, access, and administration 4. Healthy school environments: comprehensive and coordinated approach 5. Communication and confidentiality 6. Emergency response 7. Professional development and training for school personnel 8. Awareness education for students 9. Awareness education and resources for parents/caregivers 10. Monitoring and evaluation 16
- 17. 17 IDENTIFICATION OF STUDENTS WITH FOOD ALLERGIES AND PROVISION OF SCHOOL HEALTH SERVICES • Identify students with food allergies • Provisions of appropriate school health services, including medication administration • Follow state and federal privacy and confidentiality laws
- 18. 18 INDIVIDUAL WRITTEN MANAGEMENT PLANS • Individual Healthcare Plan (IHP or IHCP) • Emergency Care Plan (ECP) • Develop in collaboration with others
- 19. 19 FOOD ALLERGY ACTION PLAN
- 20. 20 MEDICATION PROTOCOLS: STORAGE, ACCESS, AND ADMINISTRATION • Allow for quick access • Protect the safety of students and the medications • Follow state laws for storage, access, and administration of medication
- 21. 21 HEALTHY SCHOOL ENVIRONMENTS: COMPREHENSIVE AND COORDINATED APPROACH Create a plan to manage food allergy across the school system • Classrooms • Cafeteria • Buses • Field Trips • Before/after school programs • School sponsored events
- 22. 22 COMMUNICATION AND CONFIDENTIALITY • Comply with state and federal privacy and confidentiality laws and accommodate parent requests, as feasible • Develop plans with the intent to inform all personnel involved in the care of a student and increase and enhance awareness of life- threatening food allergies
- 23. 23 EMERGENCY RESPONSE • Food allergy as part of an “all-hazards approach” • Written emergency procedures for dealing with a life-threatening food allergy reaction - Assure rapid accessibility to epinephrine to prevent a delayed response • Roles and responsibilities
- 24. 24 PROFESSIONAL DEVELOPMENT AND TRAINING FOR SCHOOL PERSONNEL • Check for compliance with policies and procedures • Provide annual training: • District/school policies, procedures, and plans for managing students with chronic health conditions • Basic information such as signs, symptoms, and risks associated with food allergy and anaphylaxis • Strategies that reduce the risk of exposure to identified allergens throughout the school day
- 25. 25 AWARENESS EDUCATION FOR STUDENTS • Educate all students on food allergy • Incorporate food allergy awareness as part of the district’s health education curriculum • Provide annual education: • Support for classmates with chronic health conditions, such as food allergy • Knowledge of potential allergens and the signs, symptoms and potential of a life-threatening reaction • Importance of following district health and wellness policies and relevant guidelines regarding hand washing, food-sharing, allergen- safe zones, and student conduct.
- 26. 26 A TOPIC NOT TO BE OVERLOOKED: BULLYING • Teasing or taunting for food allergy should never be allowed; bullying could come from students, teachers, staff, or parents • For staff: Bullying prevention, including responsibility to address any harassment, hazing (e.g., forced consumption of the known allergen), or bullying and enforce consequences • For students: Bullying prevention, including reporting any harassment, hazing or bullying to appropriate school personnel. • School’s response to reported bullying should be made clear at the outset, should be followed through, and should be both therapeutic and punitive
- 27. 27 AWARENESS EDUCATION AND RESOURCES FOR PARENTS/CAREGIVERS • Provide awareness education and resources through use of qualified personnel. Increase understanding of special needs of students with food allergies. • In-person education is desirable, but written communications can also be effective
- 28. 28 MONITORING AND EVALUATION • Creating food allergy policy is a process that can be modeled after CDC’s 6-Steps Framework • Assess needs and review data • Engage stakeholders • Educate, practice and communicate about policies and programs • Focus the evaluation design • Gather credible evidence and justify conclusions • Implement needed changes and share lessons learned • Review and update policy and practices after an incident of food allergic reaction and at least annually
- 29. 29 MONITORING AND EVALUATION The guide’s policy component checklist: • Systematic approach to managing food allergies • Gauges areas that need attention and identifies specific actions for improvement • Tracks inclusion and implementation of each element
- 30. 30 MONITORING AND EVALUATION Instructions for the policy component checklist: • Check “Included” or “Not Included” for whether or not each element is in the policy • If the element is included in the policy, check if the element has been “Implemented” or “Not Implemented” in practice • Use notes section to document specific actions for improvement Optimal: Each element is both “Included” and “Implemented” at the district and school levels
- 31. 31 Elements Included Not Included Implemented Not Implemented Notes: Specify what is needed for this element to be included and/or implemented 1. Collect information on students with life- threatening food allergies 2. Coordinate a process to acquire current student information from healthcare providers and parents 3. Document and keep current parental consent for medication administration Essential Component A: Identification of students with life- threatening food allergy and provision of school health services Develop, implement, monitor, and update a school health services plan for students with food allergies in accordance with privacy/confidentiality laws. FOOD ALLERGY POLICY COMPONENT CHECKLIST Sample
- 32. 32 POLICY EXAMPLE The NSBA Food Allergy Policy Guide contains sample policies: • Liberty School District, Missouri • Waukee School District, Iowa • Connecticut Association of Boards of Education • State of Rhode Island Excerpt from Liberty School District, MO Allergy Management Policy Board Policy JHC Liberty Public Schools is committed to providing a safe and nurturing environment for students. The Liberty Board of Education understands the increasing prevalence of life threatening allergies among school populations. Recognizing that the risk of accidental exposure to allergens can be reduced in the school setting, Liberty Public Schools is Committed to working in cooperation with parents, students, and physicians, to minimize risks and provide a safe educational environment for all students. The focus of allergy management shall be on prevention, education, awareness,
- 33. 33 REFERENCES • American Academy of Allergy, Asthma, and Immunology (AAAAI) Board of Directors. (1998). Anaphylaxis in schools and other child-care settings. Journal of Allergy and Clinical Immunology, 102, 173-176. • Branum, A. M. & Lukacs, S. L. (2008). Food allergy among U.S. children: Trends in prevalence and hospitalizations. NCHS Data Brief (No. 10). • Branum, A, M. & Lukacs, S.L. (2009). Food allergy among children in the United States. Pediatrics, 124, 1549-55. • Bock, S.A., Muñoz-Furlong, A., & Sampson, H.A. (2007). Further fatalities due to anaphylactic reactions to food: 2001 to 2006. Journal of Allergy and Clinical Immunology, 119, 1016-1018. • Centers for Disease Control and Prevention. (2009). Framework for program evaluation in public health. MMWR: Recommendations and Reports. 48, 1-40. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm • Decker, W.W., Campbell, R.L., Manivannan, V., Luke, A., St Sauver, J.L., et al. (2008). The etiology and incidence of anaphylaxis in Rochester, Minnesota: A report from the Rochester Epidemiology Project. Journal of Allergy and Clinical Immunology, 122, 1161-1165. • Food Allergy &Anaphylaxis Network (FAAN). (n.d.). Frequently asked questions. Retrieved from http://www.foodallergy.org/questions.html • Lieberman, J.A., Weiss, C., Furlong, T.J., Sicherer, M., Sicherer , S.H. (2010). Bullying among pediatric patients with food allergy. Annals of Allergy, Asthma & Immunology, 105, 282-286. • Massachusetts Department of Education. (2002). Managing life threatening food allergies in school. Retrieved from http://www.doe.mass.edu/cnp/allergy.pdf • National Association of School Nurses (NASN). (2010). Position statement: Delegation. • NASN. (2004). Position statement: Rescue medications in school.
- 34. 34 REFERENCES •New York State Department of Health, New York State Education Department, & New York Statewide School Health Services Center. (2008). Making the difference: Caring for students with life-threatening food allergies. •One Hundred Eleventh Congress of the United States of America. (2010). H.R. 2751: FDA Food Safety Modernization Act. Retrieved from http://www.gpo.gov/fdsys/pkg/BILLS-111hr2751enr/pdf/BILLS- 111hr2751enr.pdf •Rotrosen, D., & Fauci, A. (2008). Raising awareness of the personal and research challenges of food allergy. Retrieved from http://www3.niaid.nih.gov/news/newsreleases/2008/food_allergy08.htm •Sheetz , A. H., Goldman, P. G., Millett, K., Franks, J. C., McIntyre, C. L., Carroll, C. R., et al., (2004). Guidelines for managing life-threatening food allergies in Massachusetts schools. Journal of School Health, 74, 155-160. •Sicherer, S.H., Furlong, T.J., DeSimone, J., & Sampson, H.A. (2001). The U.S. peanut and tree nut allergy registry: Characteristics of reactions in schools and child care. Journal of Pediatrics, 138, 560-565. •Sicherer, S.H., Mahr, T., & the Section on Allergy and Immunology. (2010). Management of food allergy in the school setting. Pediatrics, 126, 1232-1239. •U.S. Department of Agriculture Food and Nutrition Service. (2001). Accommodating children with special dietary needs in the school nutrition programs. Guidance for school food service staff. Retrieved from http://www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf •U.S. Department of Education. (2000). Office of Civil Rights memorandum regarding the prohibition of disability harassment. Retrieved from http://www.ed.gov/about/offices/list/ocr/docs/disabharassltr.html • U.S. Department of Education. (2007). Free appropriate public education for students with disabilities: Requirements under Section 504 of the Rehabilitation Act of 1973. Retrieved from http://www.ed.gov/about/offices/list/ocr/docs/edlite-FAPE504.html • Young, M.C., Muñoz-Furlong, A., Sicherer, S.H. (2009). Management of food allergies in schools: A perspective for allergists. Journal of Allergy and Clinical Immunology, 124, 175-182.
- 35. 35 FOOD ALLERGY RESOURCES: www.foodallergy.org www.nasn.org www.cdc.gov/healthyyouth/ National School Boards Association Division of Adolescent and School Health (DASH) www.nsba.org/schoolhealth www.fns.usda.gov/cnd/guidance/special_dietary_needs.pdf
- 36. 36 THANK YOU WHAT QUESTIONS DO YOU HAVE? For more information contact: National School Boards Association, School Health Programs 703-838-6722 SchoolHealth@nsba.org www.nsba.org/SchoolHealth
Hinweis der Redaktion
- Presenter introduces self and welcomes the group. Group Introduction, if time allotted. Open up a discussion: What experiences have you had with food allergies in schools? This presentation is based upon the policy guide titled Safe at School and Ready to Learn: A Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies, published by the National School Boards Association in 2011 with support from the Centers for Disease Control and Prevention. While this presentation was developed primarily for school policymakers, it can be modified to make it appropriate for a variety of audiences, including school administrators and other school personnel, parents, healthcare providers, and others. The purpose is to make sure that all stakeholders have a clear understanding of the why and how of addressing food allergies in the school setting.
- There are four (4) objectives for the session Develop Awareness (kind of food allergies, symptoms and what a severe reaction [anaphylaxis] looks like) Learn why schools should address food allergies Understand the components of food allergy policy Learn about key resources related to food allergy We’ll start out with a review of Food Allergy Basics. The next slides will review these areas giving guidance on how to manage food allergies in schools.
- The definition of food allergy and when food allergy occurs appears on this slide. The body’s immune system responds to the presence of a food protein in the form of a reaction. There are distinct symptoms of food allergic reactions that will be reviewed in this presentation.
- There has been an increase in food intolerance. People often confuse food intolerance with food allergies. Common symptoms of food intolerance are gastric discomfort and diarrhea. Eliminating the food will eliminate the symptoms. The example of lactose intolerance is presented here. Other common food intolerances that you might hear about are: Gluten or Monosodium Glutamate (MSG).
- The Food Allergy and Anaphylaxis Network, FAAN, reports in their “Frequently Asked Questions” section that one or more food allergic symptoms can occur within minutes up to hours after eating the food and the symptoms can be mild to life-threatening. Not everyone is aware of the symptoms of food allergic reactions and a delay in responding to the symptoms can be life threatening. Education and training is encouraged to increase the awareness of food allergy with all members of the school community. According to an article in the Journal of Pediatrics by Dr. Scott H. Sicherer (Sish- err – err) in 2001, foods used in class projects or celebrations are the primary cause of allergic reactions in school: 79% of reactions occurred in classroom and 12% of the reactions occurred in the lunchroom.
- Severe allergic reactions are known to be caused by: Food Insect venom Medications and Latex Anaphylaxis is the term for a serious, life-threatening allergic reaction; anaphylaxis is rapid in onset and may cause death. It is characterized by symptoms that affect multiple organ systems, of which changes in the cardiovascular and respiratory systems, such as drop in blood pressure and upper airway obstruction reducing ability to breathe are among the most severe. Not all food allergic reactions result in anaphylaxis, but food allergies are the leading cause of anaphylaxis outside of the hospital setting. Administering the medication, epinephrine, by injection is the treatment for anaphylaxis. Question for the audience: Are you confident that school personnel know where to access epinephrine in the event of an emergency?
- In the treatment of anaphylaxis with epinephrine, quick administration is key; a delay can be deadly. A serious food allergic reaction is an EMERGENCY. Identify personnel to administer medications. Epinephrine is relatively safe and its side effects, if administered unnecessarily, are mild and temporary. The actual location of the epinephrine should be carefully considered and identified in a student’s individual written management plan. Call 911 when anaphylaxis is suspected. Notify the emergency medical service that anaphylaxis is suspected so they will bring epinephrine. If there is time and interest, here are some questions for the audience: Do school personnel, other than the school nurse, know where the medication is stored? (Information to formulate answer if needed: Store emergency medications in a safe, appropriate, and secure, yet accessible location that will allow for rapid, life-saving administration by authorized personnel. Actual location of the medicines should be carefully considered and identified in a student’s individual written management plan, and all those involved with the student’s care should be notified where the medication is stored.) When students are identified as having a life-threatening food allergy, is information available on which students carry their own medication, called epi-pens? (Information to formulate answer if needed: Schools need to develop and maintain an individual healthcare plan to address the student’s medical needs and any special accommodations. As a nursing document, this plan responds to the day-to-day management of food allergy and includes student’s personal identification information, allergens, signs and symptoms of an allergic reaction, how a student might alert others to his or her signs or symptoms, medication and treatment information, emergency contact information, instructions to activate emergency services, and other details necessary to effectively manage the student’s food allergy at school. Schools need to receive and retain written orders from the licensed healthcare provider and parent for students with life- threatening food allergies, including permissions for students to carry and self-administer their own life-saving medication at prescribed dose (i.e., epinephrine auto-injector). These students should keep the medicine on their person at all times. Assure permission to carry and self-administer prescribed medications is developmentally appropriate, in accordance with state or local legislation regarding self-carrying, and procedures are established and followed for immediate follow-up to any medication administration to facilitate easy access while maintaining safety and security.)
- There are compelling reasons why schools should be prepared to address food allergies. Schools have a responsibility to care for health and safety of children under their care A first food allergy reaction could happen at school. Delay in providing epinephrine and effective emergency response can result in fatalities, so there’s a need for immediate response and schools must establish an emergency care plan for all students with food allergies. Food allergies could be a complicating factor when dealing with other conditions. For instance, coexisting conditions like asthma can increase the risk of anaphylaxis and food allergies can worsen conditions for those who have asthma, because it contributes to bronchial spasms and narrowing. Students with food allergies have unique social and emotional challenges, as do students with other health conditions or perceived differences. For example, they might feel or be excluded from engaging in certain activities involving food with their peers of experience extreme anxiety related to their food allergy that could affect their schoolwork, relationships, etc.
- The presence of food allergies among children and adolescents has increased: Between 1997 and 2007 the prevalence of reported food allergies in people under the age of 18 increased 18% according to the CDC (as reported in Branum and Lukacs, 2008) In 2007, approximately 3 million children under age 18 years (3.9%) were reported to have a food or digestive allergy in the previous 12 months The increase over the 10 year period was in pre-school and school-age children One in 25 Americans, or 4% of the population, has a food allergy Here are some theories for the increase in food allergy. Remember, no one knows for sure why there have been such increases. Better diagnosisIncreased awareness and media attention Increases across different demographics Changes in the environment Increasingly, schools need to provide services for students with chronic health conditions, including diabetes, asthma, epilepsy, and other conditions requiring routine medications or services. Schools have a critical role in preventing medical emergencies as well as responding to such emergencies.
- A student with a life-threatening food allergy may be considered disabled by his/her healthcare professional. The laws that govern the disability are: The Rehabilitation Act of 1973, The Individuals with Disabilities Education Act, The Americans with Disabilities Act, and the Americans with Disabilities Amendments of 2008. The determination of whether a particular student is eligible under Section 504 is made on a case-by-case basis by a licensed healthcare provider (e.g., primary care provider, allergist). Generally, a life-threatening food allergy alone is not considered condition warranting protection under IDEA, the federal special education law. However, some students may have both a life-threatening food allergy along with a condition that impacts learning, such as a hearing/visual impairment. For such students, IDEA coverage generally applies, as opposed to Section 504, and an Individual Education Plan (IEP) is developed for that particular child. A student with a life-threatening food allergy may be considered disabled by his/her healthcare professional. The laws that govern the disability are: The Rehabilitation Act of 1973, The Individuals with Disabilities Education Act, The Americans with Disabilities Act, and the Americans with Disabilities Amendments of 2008. Not all students with food allergy require a 504 Plan (or IEP). Appropriate accommodations might also be documented in an Individual Healthcare Plan (IHP or IHCP), which will be discussed in more detail later. A diet prescription form, completed by a licensed healthcare provider, needs to be included in the 504 Plan or the IHP to direct school nutrition staff to make appropriate accommodations. FERPA and HIPAA are federal privacy laws. The parent or caregiver can file a civil rights claim with the U.S. Department of Education Office of Civil Rights on behalf of the student if the governing laws are not followed.
- In order to manage food allergies in the school environment, there are three key factors: Shared responsibility among schools, students, families, and healthcare providers Avoidance of the known food allergens and Being prepared in case of a reaction To be successful in avoidance of food allergens, make wise choices, read labels, and ask questions. Those who prepare the food must be careful to take necessary steps during preparation and clean up to prevent cross-contamination. Establishing and practicing a school emergency response plan helps with preparation in case of a reaction. Medications should be available at all times to allow for quick administration and understanding the symptoms of an allergic reaction will support a quick response. Each of these three factors will be discussed in some detail.
- At the core of managing food allergies is a partnership with open communication and education for all those involved with the child’s care. These are some examples. School’s responsibility Create an environment where children with food allergies will be safe Use prevention and avoidance strategies Be prepared to handle an allergic reaction Address teasing – bullying 2. Family responsibility Notify school of the child’s allergies Provide written medical documentation, instructions, and medications as directed by physician Provide properly labeled medications, keep them current Provide emergency contact information 3. Student’s Responsibility No food trading Don’t eat anything with unknown ingredients or a food known to contain allergens Be proactive in managing their own food allergy depending on their developmental level Notify an adult immediately if something is eaten that may contain an allergen 4. Healthcare Provider’s Responsibility Diagnose food allergy and prepare a medical treatment plan Educate students, families, and school community about food allergy Provide needed and updated documentation to school Be realistic about the schools capacity to safeguard the student
- It is important to understand there currently is no cure for food allergies. Avoiding foods known to cause food allergy is the only way to prevent an allergic reaction. There are eight (8) foods that account for ninety (90) percent of all food allergic reactions in the United States. These known allergens are found in many foods; manufacturers are required to list the ingredients on the label, though there are no guarantees that all ingredients will be listed. There is an art to reading labels and you’ll find that parents of children with food allergies and food service professionals are quite skilled at reading labels. You are encouraged to read food labels to see how many of these foods you can identify. For example, if a food has “Arachis (are-ak-iss) Oil” listed on the label, a child with a peanut allergy cannot eat that food. You might be surprised to learn that the biological name for the peanut plant is Arachis?
- Please reflect on the information that has just been presented: a Review of Food Allergy Basics. What questions come to mind? It is possible that the review of food allergy basics and why schools should address food allergy has raised many questions. Here is a question for the audience: Does your school district have a food allergy policy and what are the key components of the policy? NSBA’s Comprehensive Policy Guide for Protecting Students with Life-Threatening Food Allergies can serve as a valuable resource as you prepare food allergy policies. It helps fulfill a need for credible information/policy guidance for education officials on food allergy and anaphylaxis. When a policy is implemented, it guides actions. Policy becomes a driver for use of resources. Families of student’s with life-threatening food allergies and the students rely on policy to guide actions to keep them safe in school.
- Basics of Food Allergy that we’ve discussed are included in NSBA’s Policy Guidance.
- The policy guide includes ten (10) essential policy components that we’ll review. We will explore each in greater detail.
- The first essential component of the NSBA Food Allergy Policy Guide is to identify students with life-threatening food allergy. Schools can systematically collect food allergy information on students with life-threatening food allergies. You’ll have to establish and coordinate a process to acquire this information from each student’s licensed healthcare providers and/or parents. School personnel would be trained to ensure the provision of appropriate school health services. Your system should include maintaining and updating student health records consistent with privacy rights and confidentiality laws. For instance, it’s important to limit access to identifiable information to those designated in partnership with family. You should periodically review operating procedures to identify students and revise procedures as needed.
- Develop and maintain an individual healthcare plan and an emergency care plan to address the student’s medical needs and any special accommodations. The IHP is a nursing document and responds to the day-to-day management of food allergy. The ECP is aligned with the IHP and written in terms for use by non-licensed school personnel (e.g., administrators, teachers, food service personnel, etc. that are a part of the food allergy management team. Both plans should be revised as needed for student’s age/developmental level and be consistent with state/federal confidentiality laws. Designate an individual who is responsible for establishing and monitoring the individual written management plans. Develop medication storage policies and maintain allergy incident reports and follow-up if there is a reaction. Collaboration is key in the development of these plans. Collaborate with the registered nurse or designee, student’s parents, district or school nutrition staff, and licensed healthcare providers to create the plan. When the student’s diagnosis indicates a disability because of the food allergy, a 504 Plan and/or an IEP should be considered.
- Here is an example of an Allergy Action Plan that is available on the FAAN website. Some districts use this plan as the emergency care plan for addressing food allergies in schools, and both FAAN and the National Association of School Nurses (NASN) support it as such.
- Receive and retain written orders from the licensed healthcare provider for medication, identify authorized personnel to administer medications (most commonly the registered nurse), and determine where medication will be stored safely but not locked. Remember, every plan should allow for quick access if and when the medication is needed. Any medication that is administered should be documented in the student’s file, whether the medication is administered at school or during off-site school related activities (e.g. field trips), and parents should be notified of the administration.
- Consider all areas of the school environment when making policy and plans for food allergy. It’s important to develop a comprehensive and coordinated approach for the management of food allergies across the school system. Here are some examples from the guide: In the Classroom: Limit or reduce the presence of identified allergens in classrooms, implement appropriate hand washing procedures, and communicate appropriate conduct to all students. In the Cafeteria: Enforce responsibilities of school nutrition staff and contracted food service staff and identify specific areas/tables that will be “allergen-safe” being aware of confidentiality concerns. Some districts have chosen to ‘ban’ known allergens; this strategy is challenging to manage and enforce. On the Bus: Enforce no eating policies, require bus companies and personnel to be familiar with local EMS procedures, and equip all school vehicles with functional two-way communication devices. Field Trips, Before/After school programs and School sponsored events: Consider allowing parents to attend the field trip/activity as an extra precaution. Delegate responsibilities for carrying necessary medications. Promote and monitor good hand washing practices and discourage trading of food and sharing of utensils.
- Increase and enhance awareness of life-threatening food allergies and employ the shared responsibility that was suggested earlier where there is open (and ongoing) communication and education among schools, students, families, and healthcare providers.
- There are four phases of emergency management: prevention: mitigation, preparedness, response, and recovery. Include responding to life-threatening food allergies as part of an “all-hazards approach” that addresses the wide array of situations including health, fire, weather, terrorist, and other emergencies. For instance, during a lockdown, access to epinephrine needs to be planned for and availability of foods safe for students with food allergies needs to be available. The policy guide emphasizes the need for written plans to manage and respond to food allergic reaction emergencies. Epinephrine needs to be accessible at all hours when the school is in session. Clearly identify the roles and responsibilities of those involved. Details of what to do and when to take action in a moment’s notice where every second counts are included in the policy guide. For example, identify adult personnel who will: Remain with the student and assess the emergency at hand Administer medication Activate an emergency response team Contact the student’s parent Meet EMS at school entrance and direct EMS to the site of the incident Accompany student to emergency care facility and assist the student with re-entry into school Manage crowd control and attend to student’s classmates Document any food allergy incidents in the student’s file
- Professional development and training for school personnel is needed to support students with life-threatening food allergies and respond to an emergency. It is important to also include training for others working with students who have food allergies like substitute teachers and volunteers. A few areas to include in the annual training for identified staff are included here. Beyond education, additional skill instruction and practice will be needed for those specifically assigned to administer epinephrine or who are likely to be present during an allergic reaction. A child with a life-threatening food allergy may be considered disabled by his/her healthcare provider. Awareness of the federal laws that govern the disability should be included in the training. We discussed relevant laws and liability earlier in the session. Annually conduct the training and check for compliance to the policies and procedures you develop.
- Students can be tremendous advocates for health. We want them to know and understand food allergies. All students should be educated about food allergies; those with and those without food allergies. Students with food allergies have presented their stories publicly in such venues as: FAAN meetings and During NSBA’s Webcast hosted in collaboration with the Missouri School Boards Associations’ Education Solutions Global Network Students with food allergies may inform the district about ways to improve policies and practices. Lessons for students about food allergies can be incorporated into: Family and Consumer Sciences Science Health, and Physical Education courses A few areas to include in education for students are included here.
- In September 2010, it was reported in the Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), that more than 30 percent (30%) of children have been bullied, teased, or harassed because of their food allergy. Here is a story from FAAN of stopping the bullying of a student with a life-threatening food allergy: After one middle school student showed symptoms of anaphylaxis every day for two weeks, a teacher determined that the girl was being harassed by two students who were shoving peanuts in her face. School officials invited a police officer to the classroom to inform students that such behavior was considered assault, and would be processed through the juvenile courts. The harassment quickly stopped. The U.S. Department of Education (ED) clearly states that disability harassment (i.e., abusive jokes, crude name-calling, threats, physical assault, and bullying) cannot be tolerated. Where such conduct occurs, prompt and effective action should be taken. Disability harassment, according to the ED, can deny a student a free and appropriate public education and may also violate state and local criminal laws. As a fundamental action, schools must develop and disseminate an official policy statement prohibiting harassment based on disability and must establish grievance procedures that can be used to address the situation.
- Communicating with parents and caregivers in person or through written formats will answer their questions. Use qualified personnel such as a registered nurse or appropriate local licenses healthcare provider to deliver the message. You might also want to consider a prepared parent who can assist in the communication with other parents. The policy guide also has a “Glossary of Commonly Used Terms Related to Food Allergies” that can be used when preparing communication pieces.
- Process to monitor and evaluate your policies, programs and practices. Evaluation framework 1) Assess needs and review data: Important features include a) the nature and magnitude of the problem or opportunity, b) individuals that are affected, c) whether the need is changing, and d) in what manner the need is changing. Example [extracted from NSBA’s food allergy policy guide – checklist]: collect information on students with life-threatening food allergies; collect and review data on when and where medication was used and the impact on the affected individual 2) Engaging stakeholders: Involves building partnerships. Principally, stakeholders are those 1) involved in the policy or practice (e.g., school personnel), 2) affected by the policy or practice (e.g., students), and 3) decision makers to change the policy or practice (e.g., school board and administrators). Want them involved throughout evaluation process. Example: coordinate a process to acquire current student information from health care providers and parents; identify and engage a food allergy management team 3) Educate, practice and communicate about policies and programs: Information about goals and strategies. Aspects to address are need, expected effects, activities, resources, etc. Example: inform personnel of student’s individual written management plan being aware of confidentiality concerns; professional development and training for school personnel 4) Focus the evaluation design: Schools need to use time and resources for evaluation efficiently. A thorough plan creates an evaluation strategy and methods with the greatest chance of being useful, feasible, ethical, and accurate. Example: determine whether the appropriate personnel received allergy awareness training and are adequately informed and confident in performing assigned responsibilities (through use of surveys, etc.) 5) Gather credible evidence and justify conclusions: An evaluation should strive to collect information that will convey a well-rounded picture of the policy or program so that the information is seen as credible. Having credible evidence strengthens evaluation judgments and the recommendations that follow from them. Example: align recommendations with current science on food allergies 6) Implement needed changes and share lessons learned: Schools can identify improvements and apply lessons learned. How will lessons learned from evaluation be used to make policies and programs more effective and accountable? Example: incorporate lessons learned by food allergy management teams Policies and practices should be reviewed and updated at least annually and anytime there is an incident of food allergic reaction.
- NSBA’s Food Allergy policy guide has a checklist to assist with monitoring and evaluation. The policy checklist corresponding to the 10 essential elements that make up a comprehensive policy on food allergies outlined in the guide provides a systematic approach to managing food allergies and can be used to identify and track areas that are missing or need improvement.
- Here are the simple instructions for using the Policy Component Checklist. During a review, the team can check off if the component is included or not included. If the element is included in the policy, you can also check if it has been implemented or not implemented in practice. It is optimal if each element is both included and implemented at the district and school levels.
- As mentioned, the Food Allergy Policy Checklist covers the 10 components (A-J) of developing a comprehensive food allergy policy outlined in the guide. Here is a sample of the checklist showing Essential Component A: Identification of Students with Life-threatening food allergy and provision of school health services. Please take a minute to look at it.
- The policy guide contains sample policies. An excerpt from the Liberty School District in Missouri Board Policy is presented here. The policy reflects the increased prevalence, recognizes the risk of accidental exposure to allergens, and supports the commitment to work in cooperation to provide a safe educational environment for all students. There are five (5) areas of focus: Prevention Education Awareness Communication and Emergency Response
- The presentation references are noted.
- The presentation references are noted.
- The most current resources available are presented here to you. NSBA, FAAN, NASN, USDA, and the CDC have been working to update and create resources.
- This concludes the presentation. Your questions are welcome. For more information, the NSBA contact information is provided. Thank you for your attention.