Diabetes Forecast

Arkansas Law Keeps Kids Safe in School

A new Arkansas law allows trained school employees to help students with diabetes care

young boy with backpack walking to school

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Imagine having to leave work every day to give your child with diabetes insulin during school. Imagine your child left at school while the rest of the class goes on a field trip. Imagine missed recesses and skipped after-school activities.

This happens too often across the United States. A nationwide shortage of full-time school nurses is part of the problem. Reluctance to train school employees and, in certain states, laws that prevent anyone but a licensed health care professional from giving medication in school are two other barriers.

Until recently, this was the reality for children with diabetes in the Arkansas public school system. According to the 2013–2014 Arkansas School Nurse Survey, there are 1,148 public schools in Arkansas, 1,052 students identified with type 1 diabetes, and only 622 school nurses. Many schools don’t have a nurse at all. And those that do often share the nurse with other schools.

But sharing those nurses isn’t always feasible. The state is largely rural, with about half of all schools having enrollments of only 1,000 students—sometimes far fewer, says Connie Fetters, RN, CDE, advocacy chair for the American Diabetes Association in Arkansas. This makes it difficult for nurses to shuttle from one location to the next and decreases their chances of helping all of the kids who need diabetes care.

Full-time nurses aren’t a panacea, either. “Even when a school has a full-time nurse, it’s still insufficient because the school nurse can’t be in all places at all times,” says Crystal Jackson, director of the ADA’s Safe at School® program. After-school sports and field trips pose a special challenge.

The bottom line, advocates say: Nurses shouldn’t be solely responsible for the oversight and care of children with diabetes at school. “It’s a reasonable and safe standard of practice for persons other than registered nurses, with training and oversight, to be perfectly capable of helping a child with insulin,” Fetters says.

Laura Kendall, RN, an ADA advocate whose child has type 1, says parents (most of whom are not medical professionals) in families with a child with diabetes learn to manage the condition. “Teaching a teacher or a volunteer is no different than a diabetes educator teaching parents how to maintain [diabetes control for] their children,” she says.

More than that, many parents want their kids to grow into handling their own diabetes care—at home and at school.

Kendall’s middle daughter, Jane, is 8 years old and self-manages at her school. “She’s [testing] her own blood sugar, she counts her own carbs, and she is now in the process of learning how to do her own changes [to her pump’s infusion set],” says Kendall. Being able to do these tasks herself allows Jane some semblance of comfort, safety, and confidence outside of her home environment—something Kendall says all kids should experience.

Fortunately, a new legislative effort led by the American Diabetes Association has helped ensure Arkansas students with diabetes are medically safe at school. “We needed [a Safe at School] bill in order for children to be self-sufficient and independent,” Kendall says. The new law aims to provide the assistance kids need as well as allow those who can check their own blood glucose and inject their own insulin to do so, with or without a school nurse or supervision.

The Influencers

The Safe at School bill was first introduced in the Arkansas Legislature in 2013 by Sen. Joyce Elliott (D-Ark.). It allows schools to train school employees who volunteer to administer insulin to kids with diabetes, says Veronica De La Garza, the Association’s advocacy director for Arkansas.

Just as instrumental at getting the bill off the ground were volunteers like Kendall, many of whom had firsthand knowledge of diabetes discrimination. “I guess you can say I kind of took it personally,” says Carol Nichols, an Association diabetes advocate whose 18-year-old daughter, Kristin, has type 1 diabetes. Nichols joined Kendall in giving testimony during the Senate and House hearings, sharing her personal story of life as a parent of a type 1 student and explaining why it was so important to pass this bill.

States with recently passed Safe at School laws:

Arkansas, Nevada

Ohio, Alabama, Tennessee, Kentucky

Arizona, Missouri

Find out which laws and resources exist in your state at diabetes.org/kidswin.

When her daughter went to kindergarten, Nichols learned that their school district did not have a full-time nurse. “It was very scary,” she says. “I thought, ‘What are we going to do? We’ve got to have help.’ ”

Kristin had to transfer to a school in a neighboring district that did have a full-time nurse. But there were still challenges: “Sometimes the school nurse might be out, and I’d have to arrange to take the day off and kind of camp out at school or be on call,” she says. Nichols was fortunate that her workplace was understanding of her need to leave work at a moment’s notice. Many parents do not have that luxury.

Had a Safe at School law been in place back then, Nichols would have had a strong and clear legal tool at her disposal. She could have asked one of Kristin’s teachers, who also had diabetes, to volunteer to deliver Kristin’s insulin.

Fetters played an important role, too, encouraging ADA board members to write to their legislators to vote in favor of the bill and acting as the primary health care witness during the hearings.

De La Garza made a big impact in her own way. As an advocacy director, it was her job to manage the whole process of legislation, from lining up support at the capitol and discussing who would sponsor the bill to creating a road map for success.

The Bill’s Opposition

After its introduction in 2013, the bill passed in the Senate but was defeated by the House Education and the Workforce Committee. The opposition came from school nursing associations, taking the position that only a school nurse could administer insulin to children at school under state law.

Then, in October 2014, talk of the bill resumed. As in 2013, the opposition in 2014 came from the same school nursing associations. The issue seemed to be the nurses’ concern about job security, says Elliott. “It was important from my standpoint that this was not about their jobs,” she says.

But even then, the tide was shifting. The success in 2015 started with lobbyists Leo Hauser and Marvin Parks, who secured two sponsors who really understood the bill: Rep. Bill Gossage (R-Ark.) and Elliott. Both had spent more than 30 years as educators in the school system, which bolstered their support of the bill.

The renewed energy and passion for the bill in 2015 made a difference in the outcome, says De La Garza.

The Bill’s Journey

The bill went through five steps before it was signed into law:

  1. House Committee: The first step in the process was for Gossage to introduce the bill to the Arkansas House Education Committee. During the committee meeting, Gossage answered questions about the bill, and Fetters, who has been a certified diabetes educator and registered nurse for more than three decades, responded to medical and safety questions. The volunteers gave testimony about their experiences as parents of children with diabetes in the school system. The committee approved the bill and it moved on to the House floor.
  2. House Floor: When the bill hit the House floor, members of the Arkansas Legislature debated the pros and cons. Speaker of the House Jeremy Gillam (R-Ark.) supported and advocated for the bill. It passed 79 to 4.
  3. Senate Committee: Elliott introduced the bill to the Senate Education Committee, and—as they did in the House—Fetters answered medical questions and volunteers gave testimony. There was quite a bit of opposition from the school nursing associations, but the bill passed and went to the Senate floor.
  4. Senate Floor: Here there was some discussion of merits and drawbacks, but ultimately the bill passed 30 to 1.
  5. Governor Signing: A public event was held on April 2, and the bill was signed into law. It will take effect sometime this July.

Despite the opposition, Gossage was confident the bill would pass. “If it’s a common-sense bill, they’re going to vote for it, and I think that’s what happened here,” says Gossage. One of the points he drove home in the hearings was that the training was voluntary, not mandatory—something that had been a sticking point for the opposition. “The attending physician has to sign off. The parents have to sign off,” he says. “There is an appropriate amount of safety [in the bill].”

The new law gives schools another way to meet legal obligations laid out through federal laws such as Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act. “If there isn’t a school nurse available, [schools] have another way that they can provide care to the child, thereby meeting their obligations under federal law,” says Jackson. That’s a good incentive for school districts to train employees who volunteer.

The New Law

When Gov. Asa Hutchinson signed House Bill 1395, Arkansas became the 28th state to meet all tenets of the American Diabetes Association’s Safe at School campaign:

  1. Allow volunteers to be trained in how to give insulin to children
  2. Allow volunteers to be trained in how to administer glucagon in a low blood glucose emergency
  3. Allow children who are capable to self-manage their diabetes at school

Unlike some other states without Safe at School protections in state law, Arkansas already had a law that allowed trained school employees to administer life-saving glucagon. “This bill took it a step [further],” says Jackson.

What does that mean in practice? “For kids who can’t self-manage and need to have an adult give them insulin, they no longer have to wait for a school nurse,” Jackson says. “[It means] that parents don’t have to leave work to come to school to give their kids insulin, and it means that parents won’t have to be present at after-school activities and field trips in order for kids to get the care they need.”

In addition, the bill strengthens existing protections for kids who are capable of self-managing their diabetes at school, says De La Garza. For instance, children must be allowed to carry their diabetes supplies with them at all times, test and treat their blood glucose without the assistance of a school nurse or other trained volunteer, and have access to a private room to perform these tasks.

The Future

From the school employee side, the bill allows workers to gain needed diabetes education and training. But the greatest benefit is, of course, to the students. The law makes it possible for kids to better focus on the most important thing: their bright futures.

Learn More

To find out more about how to keep your child safe at school by visit diabetes.org/safeatschool.



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