T1D at School: Training the School Team to Support a Student with Diabetes
D-Mom, M.S. (Psychology)
Whether your child is starting in a new school with an existing diagnosis, or returning to school after a recent diagnosis, one of your top priorities will be equipping school staff with the information and skills, both proactive and reactive, which they will need to ensure your child’s safety and to support his health. As the “hub” between your child, the school staff, and the diabetes health care team, it makes sense for the parent(s) to take responsibility to empower your child’s teachers and administrators by providing this necessary information.
Note that you do not need to create these training materials from scratch – there are a number of excellent resources available in Canada, from pamphlets to DVD’s to PowerPoint slides. We have listed a few that we have found especially helpful – see Other Resources for Diabetes at School on this website.
To “know your audience”, you may choose to start by asking whether teachers/administrators have previous experience with diabetes. If they do, they may already have some background knowledge that will help. Since every person’s experience of diabetes is unique, it is still wise to provide the planned information and training so that gaps in knowledge are filled, and information unique to your child is covered. For example, many people have experience with type 2 diabetes, and would benefit from learning how managing type 1 diabetes differs. Also, different children may look and act in different ways when their blood glucose is low. For example, my son gets very quiet and withdrawn when his blood glucose is low; in the same situation, another child we know gets aggressive and non-compliant. If teachers only look for acting-out, they will miss the child who is quiet and withdrawn; if they expect a child to become quiet when low, they may assume noncompliance during a low is behavioural rather than biological.
It is also important to note that the content and planning of the presentation will vary depending on your child’s age and ability level regarding their own diabetes self-care; younger children (particularly those in Kindergarten to grade 3, or beyond) will likely require more support than older children. A child’s transition to junior high/middle school, and then to high school, will require a shift in perspective. The issues and challenges change as a student progresses through the grade levels.
Who Attends the Training?
In deciding who at your child’s school should receive training in diabetes, it may help to think about who will have the most direct contact with her across the school week. Her classroom teacher is likely the first person to come to mind. Also consider the importance of administrators being trained in managing diabetes at school (principal, assistant principal). In addition, it may be helpful to invite other teachers, the school nurse, coaches/physical education teachers, music teachers/band leaders, the guidance counsellor, the office secretary, the bus driver, and the lunch room support staff and/or food service coordinator (all as applicable). The more people who are willing to learn, the better. The Juvenile Diabetes Research Foundation (JDRF) booklet “School Advisory Toolkit for Families” suggests “an adult and a back up”, meaning at least one adult and one “back up” should be trained to check your child’s blood glucose, to treat low blood glucose (hypoglycemia), and to handle high blood glucose (hyperglycemia). Note that busy schedules may necessitate planning more than one training session for all willing parties to participate.
These people do not need to become diabetes experts, they just need to learn the basics so they can implement the treatment decisions as recommended by the parents, and so they know where to find important supplies and information when it is needed. Your child’s health and safety rely on the adult caregivers in the school environment being able to interpret the information you have provided about your child, to understand why certain things are required, and to act to prevent or resolve an emergency situation.
Several parents we spoke to shared that they focus their training efforts on the classroom teacher and/or classroom assistant, including the gym teacher, if applicable.
Those in administration (principals, assistant principal) tend to fulfill more of an executive role and “set the tone” for what they will “allow” and/or encourage the school staff to do in terms of support, but they may not be involved in the day-to-day needs of your child. Other parents report that the principal or vice principal is directly involved. It’s also important to be prepared for changes in staff, especially from year to year. Ongoing advocacy and training is essential.
Several parents shared with us the important role filled by support staff (aides, educational assistants, lunch supervisors, caretakers, bus drivers) and the importance of establishing a strong connection with them. One parent we spoke with does extensive training with members of the support staff, separate from the training provided to teachers and administration. At the beginning of the year, she makes sure she introduces herself and her son to each one, and throughout the year makes sure to recognize their efforts separate from the teaching/administrative staff. We agree with her that often these key individuals do not get the respect, thanks or support they deserve.
Who Provides the Training to School Staff?
You may choose to use the resources suggested here to do this training session yourself, if you feel comfortable (or if there’s no one else equipped to do so). If you prefer, and if it’s an option, you may turn to someone else to provide, or to help you provide the training for school staff. You may discuss possibilities with your child’s diabetes health care team, with the school nurse, or with other diabetes health care professionals. You may even know of another parent of a child with diabetes at the same school who is willing to help.
In terms of existing educational sessions, the Alberta Children’s Hospital Diabetes Clinic has a Type 1 Diabetes and School Powerpoint Presentation that you can access in the Information section of their website. At the end of the session participants will be able to describe the basics of diabetes management, identify the role of parents and teachers in diabetes management, and learn what steps to take when faced with low and high-blood sugar.
What Information Should Be Provided?
In addition to individualized information about your child, his needs, and how diabetes is uniquely manifested for him (which is contained in your child’s Diabetes Care Plan), you may want to lead the training session with more general information about diabetes and guidelines for its management within the school environment. You may include topics such as:
Tip from the Trenches
I’ve found it useful to highlight what type 1 diabetes is not (i.e. type 2 diabetes). Many people know others with type 2, so they make assumptions that the two are interchangeable. To avoid the “been there, done that” approach, it’s best to be clear that your child cannot manage her condition with diet and exercise and that she has the same nutritional needs as any other child (sugar and fat are not forbidden, can be eaten in moderation as any other child her age).
~Lori, mom of a Grade 6 child with diabetes
Tip from the Trenches
Hyperglycemia can also interfere with following through on instructions. Our son was harshly scolded by a staff member for taking too long to change his shoes and go for recess. He had been dealing with a very high blood sugar and could barely function. This prompted us to set up some re-training, to impress upon staff that highs, too, can be debilitating. ~Parent of a Grade 3 child with diabetes
- The role of food and diabetes: the importance of carbohydrates; which foods contain carbs (and which do not); the need to balance insulin against carbs consumed; the need for your child needs to eat lunch/snacks fully and on time, and not to have carb-containing foods unless approved by the parent; “free” foods, what they are and examples, point out your child can consume them without insulin.
This may be a good place to discuss advance notice for special events (birthday parties, pizza days) so you can make plans for your child to participate, or provide a substitution (if preferred).
- The impact of physical activity, sports; the increased risks of lows after gym class or on sports days.
- The impact of illness, which can make blood glucose levels unpredictable; vomiting may lead to an emergency situation, especially if your child received insulin for the food that did not stay down.
- The need to monitor blood glucose before snack/lunch, before exercise, and if low blood glucose is suspected.
- Myths and Facts:
- My child CAN eat sugar, he just needs insulin for it.
- My child CAN participate in all the same activities as other students – and we want him to! – but it will take extra preparation and communication.
How Do We Follow Up in the Classroom?
Providing the theoretical information is one thing; putting it into practice is another. The first few weeks of September are universally unpredictable, sometimes even chaotic. Teachers may still be working out classroom routines and getting to know all their students; methods for fitting diabetes care into those routines may still need to be worked out. Some parents plan on being available via phone for those first few weeks especially, to provide instruction and support to their child and school staff. Other parents plan on being available in person, slipping into the classroom around gym and snack times to complete or supervise blood glucose checks and insulin administration. Other parents plan on being in the classroom full-time this first week or two as a general parent volunteer, assisting the teacher with general classroom set-up and organization tasks while also keeping an eye out for their child’s medical needs. Different approaches will work for different families, depending on each family’s resources and the student’s needs (i.e. Is a parent available during school hours? Can he or she take time off from work, from siblings and other responsibilities? Is the student able to check his own blood glucose and give himself insulin? These factors will affect your plans for the first few weeks of each new school year.) Whatever you decide and can work out with your child’s school, some sort of follow-up is helpful, to ensure that the plans laid out in theory are being put into practice within the school environment.
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Tip from the Trenches
An Aside from Michelle: This was a challenging section for me to write. Many of us parents find it hard to trust others to care for our children in our absence, even when a life-threatening illness is not part of the equation; how much harder to trust someone else to keep my child safe when there are very real risks present? Even that phrase “life-threatening illness” is not one that I like to acknowledge applies to my son. But in order to enhance my son’s safety, I have to make contingency plans for what could go wrong. In making contingency plans, I am forced to think about what could wrong, which is not a pleasant trip. But again quoting my husband, Dean, “It is what it is”, and we need to deal with what is. I would rather think about and plan for what could go wrong and thereby decrease the chances of it happening, than have things sneak up on me without an effective way to handle it. So we took the unpleasant trip, and this article is the result. I hope it makes your trip a little more bearable.
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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