Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Accommodating Disabilities in the School Meal Programs
State Agency Training Modified January 2019
Presented by Dana Parker, Director of Training
Presenter
Presentation Notes
I would like to welcome everyone to the State Department of Education, Child Nutrition's Webinar for Accommodating Disabilities in the School Meal Programs. I am Dana Parker, the Director of Training for the Child Nutrition Programs at the State Department of Education. You may type in your questions and we will try to address them as we have time or we will send out questions and answers to participants, along with certificates after the Webinar. I will post the PowerPoint to CARS in a few days. Now let’s get started!
Introduction
• NSLP & SBP aim to provide all children with nutrition meals regardless of background
• SFA’s must comply with USDA regulations• This includes ensuring children with
disabilities equal opportunity to participate in programs
• 2.8 Million school aged children with disability in 2010
Presenter
Presentation Notes
In 2010 the US Census Bureau showed that 2.8 Million school aged children were reported to have a disability. It is imperative that SFA’s recognize the importance of ensuring access to meal benefits and understand their obligation to provide reasonable modification for children with disabilities. This information not only encompasses the NSLP and SBP, but also the CACFP, FFV, SMP, and the After School Snack program. SFA’s enter into agreements with respective State Agency, as part of this agreement the SFA must comply with the USDA Regulation Non Discrimination on the Basis of Handicap in Programs or Activities Receiving Federal Financial Assistance [7CFR 15b]
Civil Rights Program Authorities
• Title VI of the Civil Rights Act of 1964 • Civil Rights Restoration Act of 1987 • Section 504 of the Rehabilitation Act of 1973 • Americans with Disabilities Act (ADA) of 1990 • ADA Amendments Act of 2008 • Title IX of the Education Amendments of
1972 • Age Discrimination Act of 1975
Presenter
Presentation Notes
These are the Civil Rights Acts from 1964 until now that Govern our NSLP and SBP Programs. These are not necessarily all inclusive of the Civil Rights Regulations. These were found in the Introduction for this training.
Civil Rights Program Authorities (cont’d)
• 7 Parts 15, 15a, 15b and 15c • FNS 113-1 and its Appendices • Executive Order 12250 (Disability) • USDA LEP Guidance • 28 CFR 41 (Government-wide 504
Regulation) • USDA Departmental Regulation 4330-2 • And many more…
Presenter
Presentation Notes
As you see there are many regulations that encompasses the Child Nutrition Programs and the disabilities of students eating in our cafeterias.
Recent Guidance
• Memo SP 59-2016 Policy on Modification to Accommodate Disabilities in School Meal Program
• Memo replaces FNS Instruction 783-2 Rev 2 Meal Substitution for Medical or other Special Dietary Reasons
Presenter
Presentation Notes
SP 59-2016 Requires SFA’s to make reasonable modifications to accommodate children with disabilities which restrict their diet. The information for this training was taken from the USDA-FNS, “Accommodating Children with Disabilities in the School Meal Programs” dated 7/25/2017
ADA Amendments Act of 2008
• EXPANDED AND CLARIFIED the definition of Disability.
• DID NOT change the expectation to provide a Reasonable Modification.
• DID make very clear that the emphasis must be on providing the reasonable modification, not placing a high burden on the disabled person to prove he or she has a disability.
Presenter
Presentation Notes
According to the ADA (Americans with Disabilities Act)the term “disability means: A physical or mental impairment that substantially limits one or more major life activities of such individual. A record of such an impairment; or 3. Being regarded as having such an impairment.
ADA Amendments Act of 2008
• Better align with Congressional intent• SFA would work with families to ensure children
with a disability have equal opportunity• LEA or SFA should not engage in weighing
medical evidence against legal requirements to determine if medical or physical condition meets the disability definition
• Most physical and mental impairments constitutes a disability
Presenter
Presentation Notes
To better align with Congressional intent, the memorandum (SP 59-2016 and SP 26-2017) incorporated important changes to the interpretation of the term “disability” included in the Americans with Disabilities Act (ADA) Amendments Act of 2008. Additionally, the memorandum emphasized the main focus for SFAs, should be working collaboratively with families so that children with disabilities have an equal opportunity to participate in and benefit from the NSLP and SBP. SFAs and local educational agencies (LEAs) should not be engaged in weighing medical evidence against legal requirements in order to determine if a medical or physical condition meets the definition of a disability. After the passage of the ADA Amendments Act, most physical and mental impairments constitute a disability. Additionally, on May 1, 2017, FNS issued SP 26-2017: Accommodating Disabilities in the School Meal Programs: Guidance and Questions and Answers (Q&As). The Q&As discuss relatively common situations which have raised questions in the past and provide direction for SFAs working to ensure children with disabilities have an equal opportunity to participate in the School Meal Programs. The Q&As are available at: https://www.fns.usda.gov/school-meals/accommodating-disabilities-school-meal-programs-guidance-and-qas.
Memo SP 26-2017
• Question and answer discusses common situation found
• Ensures SFA’s are working with participants to ensure equal opportunities to all
• Website: https://www.fns.usda.gov/school-meals/accommodating-disabilities-school-meal-programs-guidance-and-qas
Presenter
Presentation Notes
Additionally, on May 1, 2017, FNS issued SP 26-2017: Accommodating Disabilities in the School Meal Programs: Guidance and Questions and Answers (Q&As). The Q&As discuss relatively common situations which have raised questions in the past and provide direction for SFAs working to ensure children with disabilities have an equal opportunity to participate in the School Meal Programs. The Q&As are available at: https://www.fns.usda.gov/school-meals/accommodating-disabilities-school-meal-programs-guidance-and-qas
Expanded Definition of Disability Major Life Activities • Seeing, hearing, • Walking • Speaking, learning,
reading • Eating • Breathing
Major Life Activities• Major Bodily Functions• Digestive• Immune system• Respiratory• Circulatory• Neurological/Brain
Presenter
Presentation Notes
ADA lists several examples of “major life activities, that could be impacted by a disability. According to the statute these include but are not limited to: caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working. Major Life Activities include Major bodily function, to include but not limited to: functions of the immune system, normal cell growth; digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.
School Food Service Scenario (1)
• Question: A child with autism is very sensitive to food textures, and will only eat foods with a smooth texture. Is the child’s condition considered a disability, and if so, must the school food service (SFA) make a modification for the child?
Presenter
Presentation Notes
We are going to look at a few Scenario’s throughout this presentation to help us look at real life examples of situations in schools concerning children with disabilities, This is the first, so let’s look at the question on the screen. Must you, as the SFA, make a modification for this child? Response is on next slide
School Food Service Scenario cont.
• Answer: Yes. According to the ADA any physical or mental impairment impacting the “major life activity” of eating is considered a disability. Some children with autism have sensory sensitivities and prefer food of a certain texture or color and therefore, children with autism may need other reasonable meal modifications.
Presenter
Presentation Notes
This scenario is on page 8 of the 7/25/17 manual Accommodating Children with Disabilities in the School Meal Programs.
Reasonable Modifications
• A change or alteration in policies, practices, and/or procedures to accommodate a disability
• Duty to negotiate over modification. This means simply saying “no” is almost never appropriate.
• Providing appropriate modifications is the primary objective, not searching out whether the participant has a disability or abusing the process
• On a case-by-case basis
Presenter
Presentation Notes
Once a disability determination has been made, SFAs are required to provide reasonable modifications to prevent discrimination on the basis of disability. A “reasonable modification” is a change or alteration in policies, practices, and/or procedures to accommodate a participating child’s disability. Reasonable modifications to effectively accommodate children with disabilities must be made on a case-by-case basis. A meal modification must be related to the disability or limitations caused by the disability.
The Modification Provided
• Should be related to the disability or limitations caused by the disability
• Does not have to be the modification requested
• Must (generally) be free of charge • Should be implemented even where the
person requesting modification believes more should be done
Presenter
Presentation Notes
According to USDA regulation at 7 CFR 15b.13 a SFA must make reasonable modification in a policy, practice and/or procedures to accommodate a disability that ensures children with disabilities have equal opportunity to benefit from a program. A request for a reasonable modification must be related to the child’s disabling condition.
Reasonable Modifications
• Consider costs/resources, and the participant’s age and ability
• “Stereotypes” regarding certain conditions or individuals can never drive decisions. Decisions must be based on facts
• Meal accommodations do not need to mirror the meal or meal item substituted
• “Lifestyle” choices (e.g. vegetarian) are not considered disabilities and need not be accommodated unless related to an underlying disability
Presenter
Presentation Notes
SFA should consider the cost/resources when making meal modifications, these modifications should be made on a case by case basis. If the modification is cost prohibited the SFA should consultant with the State Agency and/or consultant to discuss options. SFA’s must not stereotype a need for a modification, example on page 12 of the booklet “Accommodating Children with Disabilities in the School Meal Programs” the cafeteria manager wants to modify a students diet with the same modifications as a child in their family with the same type of issues. This is not appropriate, SFA’s must not make assumptions on what modifications to make. The meal will meet reimbursable requirements if the SFA follows what the Medical Statement, 504 plan, or IEP of a student with disabilities. Life choices however, are not considered a disability and need not be accommodated unless are followed up by a Medical Statement. Who can sign a medical statement? A State licensed healthcare professional authorized to write medical prescriptions. (March 30, 2015, http://www.fns.usda.gov/statements-supporting-accommodations-children-disabilities-cnp)
School Food Service Scenario (2)
• Question: The “regular” menu item for lunch at the local middle school is whole grain rich pasta with cheese and vegetable toppings. Must the school food service director prepare whole grain rich pasta with lactose-free cheese and vegetable toppings for a child with lactose intolerance?
Presenter
Presentation Notes
Let’s look at the scenario. Does the middle school have to make the modification of the meal for this school who is lactose intolerant with another menu item of the same exact component, having to sub the cheese with lactose-free cheese which will cost more than the regular cheese?
School Food Service Scenario (2)Response
• Answer: No. In a disability situation, the meal modification or meal item substituted does not need to mirror the menu item offered each day. The SFA’s responsibility is to serve the child a safe meal that accommodates their disability, not to mirror the Program meal served that day.
Presenter
Presentation Notes
Remember that the meal does not have to mirror the menu for the day, but you might want to add variety to a menu for a child with a meal modification. Also taking into consideration if the child is on an IEP or 504 plan that has what specific modifications to be made.
School Food Service Scenario (2)Response Cont.
• In the example used in this question, the SFA would not be required to serve a whole grain rich pasta dish, and could instead serve a different meal that meets the child’s modification request, such as a sandwich with whole grain rich bread.
Presenter
Presentation Notes
They could sub the lactose free cheese, if they chose, but they do not have to make the same exact menu, they could offer a menu entirely different to the student.
Fundamental Alteration
Exception: Modifications are not required that would fundamentally alter the nature of the program. • If the modification requested would cause
undue financial burden on the program or activity that would make continued operation of the Program unfeasible, the modification need not be provided.
.
Presenter
Presentation Notes
Fundamental Alteration is a modification so drastic that it would change the essential nature of the Program. SFAs should work closely with families to prevent any misunderstandings before declining a modification request. If an SFA declines a request, the SFA must, under the Procedural Safeguards requirements, ensure that the child’s parent or guardian understands their right to: • File a grievance if they believe a violation has occurred regarding the request for a reasonable modification; • Receive a prompt and equitable resolution of the grievance; • Request and participate in an impartial hearing to resolve their grievances; • Be represented by counsel at the hearing; • Examine the record; and • Receive notice of the final decision and a procedure for review, i.e., right to appeal the hearing’s decision. Again, I would emphasis that if the SFA feels they are not capable of making a meal modification, they should contact the State Agency and/or their Area Consultant for assistance.
Fundamental Alteration Cont.• Note: Denying a modification(s) under the
fundamental alteration exception should not result in the denial of access to the program or other benefits or services.
• Before making the decision to deny a modification should be discussed with State Agency
Presenter
Presentation Notes
Again, I would emphasis that if the SFA feels they are not capable of making a meal modification, they should contact the State Agency and/or their Area Consultant for assistance.
School Food Service Scenario (3)
• Question: A number of children at a high school receive modified meals due to a disability. The SFA has medical statements on file supporting all of the modified meals. Is the SFA eligible to receive the additional 6 cent reimbursement for compliance with the program meal pattern?
Presenter
Presentation Notes
Let’s look at this scenario, Will the SFA receive the 6 cent additional reimbursement for compliance with the program meal pattern? We are looking at the 6 cents that you receive additional for lunches served that meat meal pattern requirements. This is from the certification process that was completed either during a Administrative Review/or when you were certified during the “New Meal Patterns” by your State Agency Consultant.
School Food Service Scenario (3)Response
• Response: Yes. Modified meals that do not meet the meal pattern due to a disability are still eligible to receive the additional 6 cent reimbursement.
Presenter
Presentation Notes
In other cases, a modification may result in the service of meals that do not meet the meal pattern requirements. SFAs will receive reimbursement for a modified meal outside of the Program meal pattern when the modification is supported by a medical statement signed by a State licensed healthcare professional (see: Modifications Outside of the Meal Pattern.) The SFA will be reimbursed based on the child’s eligibility for free, reduced price, or paid meals. Additional costs may be paid from the nonprofit food service account or other funds necessary to cover the meal costs.
Major Food Allergens Resource
• US Food and Drug Administration-Food Allergies: What You Need to Know.
• http://www.fda.gov/food/ingredientspackaginglabeling/foodallergens/ucm079311.htm
Presenter
Presentation Notes
This site gives more information from the Food and Drug Administration on Food Allergies if you were to need more information.
Major Food Allergies • Peanuts • Milk • Eggs • Wheat • Soy • Tree nuts (e.g., almonds, pecans, or walnuts) • Fish (e.g., bass, flounder, or cod) • Crustacean shellfish (e.g., crab, lobster, or shrimp) • An ingredient containing protein derived from one of
the eight allergens listed above
Presenter
Presentation Notes
According to FDA, the following major food allergens account for 90 percent of all food-based allergic reactions.
Integrated Environment
• Integration clause in Section 504 requires Program operators to serve disabled individuals in the least restrictive and most integrated setting possible.
• In the food allergy context, this most often comes into play where participants with food allergies are shunned in some way during meal time.
• Providers must always balance safety vs. stigma. Age, ability and severity of allergy are the primary considerations.
Presenter
Presentation Notes
Federal Civil Rights legislation, including Section 504 of the Rehabilitation Act of 1973, IDEA, and Titles II and III of the ADA requires that must ensure children with disabilities participate along with children without disabilities to the maximum extent appropriate. This allows children to interact with and learn from other children. SFA’s may isolate eating areas for a child(ren) with severe food allergies. The SFA should get input from the student/and family before making these separations. SFA cannot segregate children due to disability as a matter of convenience. The overall message is that communication must happen between SFA Team and the student’s parent(s) or guardian(s).
Program Accessibility
• Ensure food service areas are accessible • Provide auxiliary aids and services, if
needed. Examples include- Food service aides
• Adaptive feeding equipment • Meal tracking assistance • Other effective methods
Presenter
Presentation Notes
7 CFR 15b.26(d)(2) provides: “Where existing food service facilities are not completely accessible and suitable, recipients may provide aides or use other equally effective methods to service food to handicapped person.” SFAs and LEAs are responsible for the accessibility of food service areas and for ensuring the provision of food service aides, where needed, to assist in preparing and serving meal accommodations. No additional School Meal Program reimbursement is available for these types of accommodations. However, any additional costs for adaptive feeding equipment or for aides are considered allowable costs for the nonprofit school food service action. Sources of supplemental funding may include special education funds if specified in the child’s IEP or LEA’s general account.
Food Service Scenario (4)
• Question: A large number of children in an elementary school have a peanut allergy. Should the school go “peanut-free?”
Presenter
Presentation Notes
However, under limited circumstances, it may be appropriate for children to sit at a separate table. For example, if a child requires a large degree of assistance from an aide in order to consume their meals, it may be necessary for the child and the aide to have more space during the meal service. Additionally, an SFA may determine a more isolated eating area is necessary for children with severe food allergies. The separate eating area may be a designated table in the cafeteria cleaned according to food safety guidelines (to eliminate possible cross contamination of allergens on tables and seating) or an area away from the cafeteria where children can safely consume their meals.
Food Service Scenario (4) Response
• Answer: Universal exclusion of specific foods (or food groups) is not FNS policy, but could be appropriate depending on local circumstances. However, if a school chooses to enact a universal ban, the specific allergen must never be present in the school, as the family will assume the school is a safe place for their child based on the stated ban.
Implementation & Compliance
• Develop procedures to address requests to accommodate children with disabilities
• Develop a process to provide notice to parent/guardian to explain their rights
• Use Section 504 of the Rehabilitation Action of 1973 or IDEA to fulfill requirement to maintain Procedural Safeguards for meal modifications.
• Best Practice - Assemble a Team to implement guidelines and render decisions on modification requests
Presenter
Presentation Notes
Information on this requirement can be found in USDA’s regulation, Non Discrimination on the Basis of Handicap in Programs or Activities Receiving Federal Financial Assistance at 7 CFR 15b.25 (“Procedural Safeguards”) and at 7 CFR 15b.6(b) (“Adoption of Grievance Procedures”). An overview of this requirement is also included in SP 59-2016.
USDA Prohibits the Following Discriminatory Actions
• Denying a person with a disability the opportunity to participate in or benefit from the recipient’s aid, benefit, or services.
• Providing a person with a disability an opportunity to participate that is not equal to the opportunity provided to others.
• Providing a person with a disability an aid, benefit, or service that is not as effective as the aid, benefit, or service provided to others.
• Providing a person with a disability a different aid, benefit, or service, unless doing so is necessary to provide an aid, benefit, or service that is as effective as those provided to others.
Presenter
Presentation Notes
Specific guidelines for recipients operating public elementary or secondary schools are included at 7 CFR 15b.22. These recipients must provide a free appropriate public education to all children with disabilities within their jurisdiction, regardless of the nature or severity of a child’s disability. No additional fees, except those also imposed on the families of children without disabilities, may be imposed on the families of children with disabilities [7 CFR 15b.22(c) and 7 CFR 15b.26(d)].
Medical Statement Requirements
Are required when the meal modification does not meet meal pattern requirements
– Must include• Information about the child’s physical
or mental impairment is sufficient to all SFA to understand how it restricts the child’s diet
Presenter
Presentation Notes
Certain physical or mental impairments require meal modifications that do not follow the required Program meal pattern. In a disability situation, meal modifications outside the meal pattern are reimbursable, provided the request is supported by a medical statement signed by a State licensed healthcare professional (see: Reimbursement for Modified Meals).
Medical Statement Requirements Cont.
• Statement provides sufficient information about impairment (diagnosis not required and should not be requested), how it restricts diet, and how to accommodate condition
• What must be done to accommodate the child’s disability
• The food or foods to be omitted and recommended alternative, in the case of a meal modification
Presenter
Presentation Notes
Remember, in the Child Nutrition Manual, in the Compliance Section, you will find information and an example of a Medical Statement.
Understanding the Medical Statement
• When new medical statement is submitted, SFA must work closely with Section 504/ADA Coordinator, and school nurse
• If medical statement is unclear, the SFA should contact child’s parent/guardian for an amended statement– Do not delay the meal modification– Follow portion of statement that is clear
Presenter
Presentation Notes
If a medical statement is provided and does not fully explain the modification needed, the SFA should immediately contact the child’s parent or guardian for guidance and ask the family to provide an amended medical statement as soon as possible. However, clarification of the medical statement should not delay the SFA from providing a meal modification. SFAs should follow the portion of the medical statement that is clear and unambiguous to the greatest extent possible, while obtaining the additional information. Do not Delay the meal modification so as to not endanger a student.
Brand Name Request
• If medical statement of meal modification request a brand name is SFA responsible to purchase the “Brand Name” product?
• Answer, it would depend– If the medical statement indicates a brand name
product, the SFA could discuss with parents or guardian concerning another product. If the family affirms the brand name is not necessary, the SFA could use generic brand
Presenter
Presentation Notes
In some situations, a State licensed healthcare professional may request a particular brand name of a product as a substitute on the medical statement. For example, a medical statement for a child with gluten intolerance may request a specific brand of gluten-free bread. If a modification request indicates a brand name item, in most instances, a generic brand is sufficient, unless the brand name item is medically necessary. This can be determined through the interactive process with the child’s parent or guardian. In the example above, if the medical statement lists a specific brand of gluten-free bread, the SFA could check with the family to see if it would be safe and appropriate for the SFA to provide a different brand. In this instance, the family could then affirm the brand name change.
Offer vs Serve
• Children with meal modifications must have option to select all food components/items available to other children
• SFA cannot accommodate a child’s disability by asking them to exclude a food component/item
• The SFA may not use OVS to eliminate a specific food component for a child with a disability
Presenter
Presentation Notes
At schools participating in OVS, children with disabilities must have the option to select all food components/items made available to other children. SFAs cannot accommodate a child’s disability by asking the child to exclude a food component/item from their selection. For example, a child who has Celiac disease or a gluten intolerance must have a choice of a bread/grain item that is gluten-free. The SFA may not use OVS to eliminate a specific food component for a child with a disability; in this case, the SFA must offer a grain substitute for a child who cannot consume gluten. For more information about OVS, please see Offer versus Serve Guidance for the National School Lunch Program and the School Breakfast Program, July 21, 2015, available at: http://www.fns.usda.gov/updated-offer-vs-serve-guidance-nslp-and-sbp-beginning-sy2015-16.
Procurement of Special Meals
• SFA must make reasonable modification for children with disabilities, regardless whether the SFA operates the food service or contracts with a Food Service Management Company
• Meal modification for children with disabilities must be included in the FSMC contract
Presenter
Presentation Notes
Federal regulations specifically prohibit disability discrimination through contractual means, included vended contracts. SFAs must make reasonable modifications for children with disabilities, regardless of whether the SFA operates the food service or contracts with a Food Service Management Company (FSMC). As applicable, modifications for children with disabilities must be included in the FSMC contract. SFAs that do not need dietary modifications at the time an FSMC bid is prepared should still include sufficient information in the bid to make certain the FSMC is aware that dietary modifications may be required during the term of the contract. FNS has published extensive guidance on contracting with FSMCs. This guidance is available at: SP 40 CACFP 12 SFSP 14-2016: Updated Guidance: Contracting with Food Service Management Companies, June 2, 2016, https://www.fns.usda.gov/updated-guidance-contracting-food-service-management.
QUESTIONS?
Office phone: 405-521-3327Desk phone: 405-522-5039
E-mail: [email protected]
Presenter
Presentation Notes
I hope this information will be helpful when you have children in your district that has special meal requirements, if you have questions, please call our CN Office 405-521-3327
Related Documents
