Physicians Must Communicate More With Schools
Public Health Feature - October 2005
By Erin Prather
When Kevin McMahon's 2-year-old daughter was diagnosed with type 1 diabetes four years ago, several concerns raced through his mind. After receiving a treatment plan from her pediatric endocrinologist, Mr. McMahon began considering the challenges he and his wife would face in giving their daughter the best diabetic care at all times.
"Since my daughter's diagnosis, I've met lots of kids with diabetes and have heard both good and bad stories, especially regarding care at school," he said. "Most educators are sensitive to the needs of a child with diabetes, but it only takes one poor choice by someone who doesn't understand for my child's health to be placed in jeopardy. That is one reason I lobbied for the Diabetes School Care Act."
The legislation, which took effect Sept. 1, requires physicians to give public schools management and treatment plans that clearly state the needs of their patients with diabetes. School personnel must now be trained in the students' diabetes care and also must allow students to self-manage their disease on school property. Appropriate school personnel must be trained to assist students with medically ordered diabetes care tasks.
Care may include self-checking blood sugar/glucose levels, self-administering insulin in accord with the diabetes, and self-managing low and high blood sugar/glucose levels as quickly as possible. Students may also carry required diabetes supplies or equipment and perform their self-care at any location on a school's campus.
"Requiring that physicians provide management and treatment plans to schools is a key point to this legislation," said Lawrence B. Harkless, DPM, chair of the Texas Diabetes Council. "Having the plan on file at the school makes it easier for personnel to provide more thorough care, especially if the physician and school nurse have communicated about a child's needs. Also, more school personnel will be educated about diabetes since students can now self-manage the disease in the classroom." Previously, he said, "school personnel who did not understand diabetes have unintentionally served as a barrier to proper care."
During the legislative hearings on the bill, Garland High School senior Beau Yarborough gave a personal testimony in support of the law. He recalled times when his teachers would not allow him to leave class to check his blood sugar level in the nurse's office. After pushing the issue, one teacher often made him stand in the hall for disrupting class after returning from the nurse's office. This situation came to a halt when the principal found him in the hallway and counseled the teacher about the needs of a student with the disease.
Stephen Ponder, MD, CDE, director of the Pediatric Endocrinology/Diabetes Department at Driscoll Children's Hospital in Corpus Christi, is all too familiar with such scenarios. He says children with diabetes often experience discrimination because of misunderstanding about the nature of their disease. He often encounters parents, like Mr. McMahon, who voice concerns about the quality of care their children receive at school. A few years ago, Dr. Ponder helped develop a 20-minute video, "Taking Diabetes to School," to prevent situations similar to Mr. Yarborough's.
"It was the first statewide effort to raise the level of understanding of school personnel regarding students with diabetes," Dr. Ponder said. "During a three-year time frame, 10,000 copies were made and distributed to all the schools in Texas with the generous funding and distribution efforts of the Texas Lions Foundation. The tapes have pretty much the same content as what is outlined in the Diabetes School Care Act. Now there is a whole new category of persons to assist with implementing diabetic care for children."
That new category is the unlicensed diabetes care assistants. Principals must identify one to three existing employees who are not necessarily health care professionals to be trained to provide care to a student, particularly when a school nurse is unavailable. If the school has a full-time nurse, the principal is required to seek only one staff employee. However, if the school does not have a full-time nurse, the principal must seek three.
Dr. Ponder acknowledges that some physicians may feel uncomfortable with non-health care staff performing diabetic care tasks. Yet parents who are not health professionals must administer the same type of care that the unlicensed diabetes care assistants will be expected to give. Additionally, the law requires the Texas Diabetes Council to develop guidelines for training unlicensed school personnel to act as diabetes care assistants. The guidelines are posted on the council's Web site at www.texasdiabetescouncil.org.
Jan Ozias, PhD, RN, director of the Texas Diabetes Program/Diabetes Council for the Texas Department of State Health Services, recommends physicians become familiar with the guidelines to support their communication with school nurses and principals. She also suggests that physicians refer their patients' parents to the guidelines so they understand how the schools can plan, train, and deliver the support students need.
She says the new law gives Texas schools "guidance on how to implement safe diabetic care. Every school should be equipped to assist students who have an identified health issue."
While Dr. Ozias believes most metropolitan areas will be able to implement the law, she recognizes that some rural areas will have limited access to qualified staff training. A trainer must be a health care professional with expertise in diabetes care or the school's registered nurse. She asks that physicians in those areas consider training their local school nurses and staff who will act as diabetes care assistants in districts without a nurse.
As for Kevin McMahon, he left his job in telecommunications to create new technology that automatically notifies him of his daughter's glucose levels, no matter where she is. His latest projects include the GlucoMESSENGER, a wireless messaging device that allows parents to quietly check in with their child on his or her daily diabetic care.
"The Diabetes School Care Act allows my child to have the GlucoMESSENGER with her at all times. Diabetes care is always evolving; it's comforting to know that school personnel will be aware of these changes and of the care my daughter's physician deems best for her."
Erin Prather can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629.
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